i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integratedmedicationmanagement infor mation system and integrated health care system in an integratedmedical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

Continuous medication monitoring is essential for successful management of heart failure patients. Experiences with the recently established heart failure network HerzMobil Tirol show that medication monitoring limited to heart failure specific drugs could be insufficient, in particular for general practitioners. Additionally, some patients are confused about monitoring only part of their prescribed drugs. Sometimes medication will be changed without informing the responsible physician. As part of the upcoming Austrian electronic health record system ELGA, the eMedication system will collect prescription and dispensing data of drugs and these data will be accessible to authorized healthcare professionals on an inter-institutional level. Therefore, we propose two concepts on integratedmedicationmanagement in mHealth applications that integrate ELGA eMedication and closed-loop mHealth-based telemonitoring. As a next step, we will implement these concepts and analyze--in a feasibility study--usability and practicability as well as legal aspects with respect to automatic data transfer from the ELGA eMedication service.

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot

This paper introduces the background, the content, the information management system of material supply chain integrationmanagement and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

To explore the application and integration of pharmacogenomics in pharmacy clinical practice via medication therapy management (MTM) to improve patient care. Department of Health & Human Services (HHS) Personalized Health Care Initiative, Food and Drug Administration (FDA) pharmacogenomics activity, and findings from the Utilizing E-Prescribing Technologies to Integrate Pharmacogenomics into Prescribing and Dispensing Practices Stakeholder Workshop, convened by the American Pharmacists Association (APhA) on March 5, 2009. Participants at the Stakeholder Workshop included diverse representatives from pharmacy, medicine, pathology, health information technology (HIT), standards, science, academia, government, and others with a key interest in the clinical application of pharmacogenomics. In 2006, HHS initiated the Personalized Health Care Initiative with the goal of building the foundation for the delivery of gene-based care, which may prove to be more effective for large patient subpopulations. In the years since the initiative was launched, drug manufacturers and FDA have begun to incorporate pharmacogenomic data and applications of this information into the drug development, labeling, and approval processes. New applications and processes for using this emerging pharmacogenomics data are needed to effectively integrate this information into clinical practice. Building from the findings of a stakeholder workshop convened by APhA and the advancement of the pharmacist's collaborative role in patient care through MTM, emerging roles for pharmacists using pharmacogenomic information to improve patient care are taking hold. Realizing the potential role of the pharmacist in pharmacogenomics through MTM will require connectivity of pharmacists into the electronic health record infrastructure to permit the exchange of pertinent health information among all members of a patient's health care team. Addressing current barriers, concerns, and system limitations and developing

AVN is a licensed body that performs health physics control in different types of installations, from large nuclear facilities to small dentist cabinets. AVN can also provide medical physics services for the quality control of, for instance, medical devices used in a radiology or nuclear medicine department. Radiation protection for personnel and environment (health physics) and radiation protection for the patient (medical physics) are usually treated separately, using different referential documents, such as the European Directives 96/29/Euratom for health physics and 97/43/Euratom for medical physics. This difference is also clearly reflected in the Belgium legislation (two types of accreditation/licence for inspectors, different chapters in the law,..) From a practical point of view it is sometimes rather difficult to split the task 'on site' during an inspection. An RX system not complying with radiation protection criteria can definitively affect the patient as well as the workers. On the other hand, the hospitals, cannot easily differentiate these two tasks because they are not fully aware of the legislation and they are mixing both. Taking into account the health physics guidelines as well as medical physics guidelines, we have decided to move to an integrated approach of these two concepts. (orig.)

... org Close Charcot-Marie-Tooth Disease (CMT) MedicalManagement Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medicalmanagement of CMT, see Surgery Sometimes, Bracing Often, Caution ...

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

The IntegratedMedical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...

The growing availability of continuous data from medical devices in diabetes management makes it crucial to define novel information technology architectures for efficient data storage, data transmission, and data visualization. The new paradigm of care demands the sharing of information in interoperable systems as the only way to support patient care in a continuum of care scenario. The technological platforms should support all the services required by the actors involved in the care process, located in different scenarios and managing diverse information for different purposes. This article presents basic criteria for defining flexible and adaptive architectures that are capable of interoperating with external systems, and integratingmedical devices and decision support tools to extract all the relevant knowledge to support diabetes care.

Know What to Expect When ManagingMedical Equipment and Healthcare Technology in Your Organization As medical technology in clinical care becomes more complex, clinical professionals and support staff must know how to keep patients safe and equipment working in the clinical environment. Accessible to all healthcare professionals and managers, Medical Equipment Management presents an integrated approach to managingmedical equipment in healthcare organizations. The book explains the underlying principles and requirements and raises awareness of what needs to be done and what questions to ask. I

To establish an integrativemedical approach (IMA) for clinical management of acute myocardial infarction (AMI), and to test its efficacy. IMA was preliminarily established according to the guidelines and based on the Chinese medical therapy of benefiting vital qi and promoting blood circulation. And adopting non-synchronous queue design, AMI patients were assigned to the IMA group (71 cases) and the non-IMA group (70 cases), they were managed following or didn't follow the established IMA respectively. The total hospitalization time (THT), the ICU indwelling time (ICUD) and the total medical expenditure (TME) of patients were compared between groups. Moreover, for patients received primary PCI, the time for door-to-balloon (DTB) was compared in addition. Comparisons between groups showed that THT in the IMA group was shorter than that in the non-IMA group (9.80 +/- 5.62 days vs. 12.01 +/- 7. 35 days , P < 0.05); but the difference of TME between groups was insignificant. For those received PCT, the DTB in the IMA group was shorter than that in the non-IMA group in terms of DTB time (82.56 +/- 17.36 min vs. 119.19 +/- 30.88 min, P < 0.01), THT (9.69 +/- 5.59 vs. 13.34 +/- 7.49 days, P < 0.01) and TME. Practicing IMA for AMI, which was established based on Chinese medical therapy of benefiting vital qi and promoting blood circulation, could shorten the hospitalization time of patients, reduce the DTB time and TME in patients receiving primary PCI; fully displays its significance in hospital administration and quality control on AMI.

The IntegratedMedical Model (IMM) captures organizational knowledge across the space medicine, training, operations, engineering, and research domains. IMM uses this knowledge in the context of a mission and crew profile to forecast risks to crew health and mission success. The IMM establishes a quantified, statistical relationship among medical conditions, risk factors, available medical resources, and crew health and mission outcomes. These relationships may provide an appropriate foundation for developing an in-flight medical decision support tool that helps optimize the use of medical resources and assists in overall crew health management by an autonomous crew with extremely limited interactions with ground support personnel and no chance of resupply.

Full Text Available The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the

The IntegratedMedical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed IntegratedMedical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project.

This article presents the design of a web-based knowledge management system as a training and research tool for the exploration of key relationships between Western and Traditional Chinese Medicine, in order to facilitate relational medical diagnosis integrating these mainstream healing modalities. The main goal of this system is to facilitate decision-making processes, while developing skills and creating new medical knowledge. Traditional Chinese Medicine can be considered as an ancient relational knowledge-based approach, focusing on balancing interrelated human functions to reach a healthy state. Western Medicine focuses on specialties and body systems and has achieved advanced methods to evaluate the impact of a health disorder on the body functions. Identifying key relationships between Traditional Chinese and Western Medicine opens new approaches for health care practices and can increase the understanding of human medical conditions. Our knowledge management system was designed from initial datasets of symptoms, known diagnosis and treatments, collected from both medicines. The datasets were subjected to process-oriented analysis, hierarchical knowledge representation and relational database interconnection. Web technology was implemented to develop a user-friendly interface, for easy navigation, training and research. Our system was prototyped with a case study on chronic prostatitis. This trial presented the system's capability for users to learn the correlation approach, connecting knowledge in Western and Traditional Chinese Medicine by querying the database, mapping validated medical information, accessing complementary information from official sites, and creating new knowledge as part of the learning process. By addressing the challenging tasks of data acquisition and modeling, organization, storage and transfer, the proposed web-based knowledge management system is presented as a tool for users in medical training and research to explore, learn and

Economic analysis plays a pivotal role in the management of medical store. The main objectives of this study were to consider always better control-vital, essential and desirable (ABC-VED) analysis with economic order quantity (EOQ), comparison of indexed cost and the actual cost, and to assess the expenditure for the forthcoming years. Based on cost and criticality, a matrix of nine groups by combining ABC and VED analysis was formulated. Drug categories were narrowed down for prioritization to direct supervisory monitoring. The subgroups AE and AV of the categories category I and II should be ordered based on EOQ. The difference between the actual annual drug expenditure (ADE) and the derived indexed cost using the cost inflation index (CII) was calculated. Linear regression was used to assess the expenditure for the forth coming years. The total ADE for the financial year of 2010-2011 was Rs. 1,91,44,253 which was only 7.68% of annual hospital expenditure. Using the inflation index, the indexed cost of acquisition of ADE for year 2010-2011 was Rs. 1,95,10,387. The difference between the two was estimated to be 2.11%. Thus, the CII justifies the demand of increased budget for next year and prompts us for cautious use of drugs. By taking into consideration the ADE of last 10 years, we have forecasted the budget for forthcoming years which will help significantly for making policies according to the available budget.

Full Text Available (1 Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integratingmedication therapy management (MTM services provided by community pharmacists into the clinical care teams and the health information technology (HIT infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO. (2 Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3 Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4 Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements.

In this paper, we present a proposal for the design of a telemedicine system. The system (called SIMPA) will be used for noninvasive monitoring of some vital parameters of patients with chronic diseases. The telemedicine system contains a fixed unit and some mobile units. The mobile unit contains various sensors used to gather data about vital biosignals, a transceiver and a medical processor. On the fixed unit side, the host transceiver must be compatible with the mobile transceiver. On the server side, an application analyzes and processes the data and further stores it in dedicated databases. The database support for the telemedicine application is ensured by open source technologies and already available communication infrastructures (GSM networks). The requirements for the application were thoroughly analyzed and the Entity-Relationship diagram of the system was designed and translated into relational model. SIMPA will be implemented using only free and open source technologies, which will ensure a low cost and improved extensibility and portability. We presented some design considerations for a low-cost telemedicine system. The system will help optimize medical decisions and will increase the quality of the medical act and lower the cost, to the ultimate benefit of the patient.

... Lookup > COPD > Diagnosing and Treating COPD Managing Your COPD Medications There are a range of treatment options ... each use . Types of medicines often prescribed for COPD: Bronchodilator Bronchodilators relax the muscles around the airways ...

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managedmedical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the

Examining the challenges of integratedmanagement, this book explores the importance and potential benefits of using an integrated approach as a cross-functional concept of management. It covers not only standardized management systems (e.g. International Organization for Standardization), but also models of self-assessment, as well as different types of integration. Furthermore, it demonstrates how processes and systems can be integrated, and how management efficiency can be increased. The major part of this book focuses on management concepts which use integration as a key tool of management processes (e.g. the systematic approach, supply chain management, virtual and network organizations, processes management and total quality management). Case studies, illustrations, and tables are also provided to exemplify and illuminate the content, as well as examples of successful and failed integrations. Providing a particularly useful resource to managers and specialists involved in the improvement of organization...

What is integrated pest management? Take a look at the definition of each word to better understand the concept. Two of the words (integrated and management) are relatively straightforward. Integrated means to blend pieces or concepts into a unified whole, and management is the wise use of techniques to successfully accomplish a desired outcome. A pest is any biotic (...

This paper focuses on some of the issues necessary for pipeline operators to consider when addressing the challenge of managing the integrity of their systems. Topics are: Definition; business justification; creation and safeguarding of technical integrity; control and deviation from technical integrity; pipelines; pipeline failure assessment; pipeline integrity assessment; leak detection; emergency response. 6 figs., 3 tabs.

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p management of behavioral health patients.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

Compliance-based ethics programs focus on prevention, detection, and punishment. Companies should adopt an integrity-based approach to ethics management that combines a concern for the law with an emphasis on managerial responsibility for ethical behavior. (JOW)

National Aeronautics and Space Administration — The Joint Army Navy NASA Air Force Modeling and Simulation Subcommittee's Integrated Health Management panel was started about 6 years ago to help foster...

Integrating semantic dimension into clinical archetypes is necessary once modeling medical records. First, it enables semantic interoperability and, it offers applying semantic activities on clinical data and provides a higher design quality of Electronic Medical Record (EMR) systems. However, to obtain these advantages, designers need to use archetypes that cover semantic features of clinical concepts involved in their specific applications. In fact, most of archetypes filed within open repositories are expressed in the Archetype Definition Language (ALD) which allows defining only the syntactic structure of clinical concepts weakening semantic activities on the EMR content in the semantic web environment. This paper focuses on the modeling of an EMR prototype for infants affected by Cerebral Palsy (CP), using the dual model approach and integrating semantic web technologies. Such a modeling provides a better delivery of quality of care and ensures semantic interoperability between all involved therapies' information systems. First, data to be documented are identified and collected from the involved therapies. Subsequently, data are analyzed and arranged into archetypes expressed in accordance of ADL. During this step, open archetype repositories are explored, in order to find the suitable archetypes. Then, ADL archetypes are transformed into archetypes expressed in OWL-DL (Ontology Web Language - Description Language). Finally, we construct an ontological source related to these archetypes enabling hence their annotation to facilitate data extraction and providing possibility to exercise semantic activities on such archetypes. Semantic dimension integration into EMR modeled in accordance to the archetype approach. The feasibility of our solution is shown through the development of a prototype, baptized "CP-SMS", which ensures semantic exploitation of CP EMR. This prototype provides the following features: (i) creation of CP EMR instances and their checking by

This paper describes some of the steps that Mobil has taken to enhance their crisis management capability and to improve their readiness. The approach stretches from the individual plant level to Mobil's Corporate offices in Fairfax, Virginia. Some of the lessons learned from several integrated crisis management exercises are outlined and some areas where additional industry co-operation in crisis management could pay dividends are suggested

medical and surgical interventions are accessible in the management of glaucoma. This article ..... Cannabinoids. With the recent attention cannabis has been receiving in the management of pain and other cancer related conditions, it.

Different approaches to integration of management systems (ISO 9001, ISO 14001, OHSAS 18001 and SA 8000) with various levels of ambition have emerged. The tendency of increased compatibility between these standards has paved the road for discussions of, how to understand the different aspects of ...

Background Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care. Aim To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system. Methods We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6-18) times by a median of 3 (interquartile range 2-4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0-1, range 0-13) users per case and viewed by median 1 (interquartile range 0-3, range 0-44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5-69.5) and median door-to-groin 94.5 min (interquartile range 85.5-121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%-99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%-78%). Conclusion The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.

Management of medical consumables is an important part of modern hospital management. In modern medical behavior, drugs and medical devices act directly on the patient, and are important factors affecting the quality of medical practice. With the increasing use of medical materials, based on practical application, this article proposes the management model of medical consumables, and discusses the essence of medical materials logistics management.

The goal of a data manager is to ensure that data is safely stored, adequately described, discoverable and easily accessible. However, to keep pace with the evolution of groundwater studies in the last decade, the associated data and data management requirements have changed significantly. In particular, there is a growing recognition that management questions cannot be adequately answered by single discipline studies. This has led a push towards the paradigm of integrated modeling, where diverse parts of the hydrological cycle and its human connections are included. This chapter describes groundwater data management practices, and reviews the current state of the art with enterprise groundwater database management systems. It also includes discussion on commonly used data management models, detailing typical data management lifecycles. We discuss the growing use of web services and open standards such as GWML and WaterML2.0 to exchange groundwater information and knowledge, and the need for national data networks. We also discuss cross-jurisdictional interoperability issues, based on our experience sharing groundwater data across the US/Canadian border. Lastly, we present some future trends relating to groundwater data management.

communities at risk through mass drug administration. However, we argue that treatment alone will not reduce the risk from eating infected fish and that sustainable effective control must adopt an integrated FZT control approach based on education, infrastructure improvements, and management practices...... that target critical control points in the aquaculture production cycle identified from a thorough understanding of FZT and host biology and epidemiology. We present recommendations for an integrated parasite management (IPM) program for aquaculture farms.......Fishborne zoonotic trematodes (FZT) are an emerging problem and there is now a consensus that, in addition to wild-caught fish, fish produced in aquaculture present a major food safety risk, especially in Southeast Asia where aquaculture is important economically. Current control programs target...

The integratedmedical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integratedmedical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to managemedical supply and better patient services.

A management system is developed in order to reflect the needs of the business and to ensure that the objectives of the organization will be achieved. The process model and each individual process within the system then needs to identify the drives or requirements from external customers and stakeholders, regulations, and standards such as ISO and 50-C-Q. The processes are then developed to address these drivers. Developing the process in this way makes it fully integrated and capable of incorporating any new requirements. The International Standard (ISO 9000:2000) promotes the adoption of a process approach when developing, implementing and improving the effectiveness of a quality management system to enhance customer satisfaction by meeting customer requirements. The IAEA Code recognizes that the entire work is a process which can be planned, assessed and improved. For an organization to function effectively, numerous linked activities have to be identified and managed. By definition a process is an activity that using resources and taking into account all the constraints imposed executes the necessary operations which transform the inputs in outcomes. Running a system of processes within an organization, identification of the interaction between the processes and their management can be referred to as a 'process approach'. The advantage of such an approach is the ensuring of the ongoing control over the linkage between the individual processes composing the system as well as over their combination and interaction. Developing a management system implies: identification of the process which delivers Critical Success Factor (CSFs) of the business; identifying the support processes enabling the CSFs to be accomplished; identifying the processes that deliver the business fundamentals. An integratedmanagement system should include all activities not only those related to Quality, Health and Safety. When developing an IMS it is necessary to identify all of the drivers

Aim of the project for the NPPs Kruemmel and Brunsbuettel (Vattenfall) is the integral view of the business process as basis for the implementation and operation of management systems in the domains quality, safety and environment. The authors describe the integral view of the business processes in the frame of integratedmanagement systems with the focus nuclear safety, lessons learned in the past, the concept of a process-based controlling system and experiences from the practical realization.

On-line interactive information processing system easily and rapidly handles all aspects of data management related to patient care. General purpose system is flexible enough to be applied to other data management situations found in areas such as occupational safety data, judicial information, or personnel records.

Having worked in the Employees and Commercial Payments Branch of the Financial Management Division for the past 3 summers, I have seen the many changes that have occurred within the NASA organization. As I return each summer, I find that new programs and systems have been adapted to better serve the needs of the Center and of the Agency. The NASA Agency has transformed itself the past couple years with the implementation of the Integrated Financial Management Program (IFMP). IFMP is designed to allow the Agency to improve its management of its Financial, Physical, and Human Resources through the use of multiple enterprise module applications. With my mentor, Joseph Kan, being the branch chief of the Employees and Commercial Payments Branch, I have been exposed to several modules, such as Travel Manager, WebTads, and Core Financial/SAP, which were implemented in the last couple of years under the IFMP. The implementation of these agency-wide systems has sometimes proven to be troublesome. Prior to IFMP, each NASA Center utilizes their own systems for Payroll, Travel, Accounts Payable, etc. But with the implementation of the Integrated Financial Management Program, all the "legacy" systems had to be eliminated. As a result, a great deal of enhancement and preparation work is necessary to ease the transformation from the old systems to the new. All this work occurs simultaneously; for example, e-Payroll will "go live" in several months, but a system like Travel Manager will need to have information upgraded within the system to meet the requirements set by Headquarters. My assignments this summer have given me the opportunity to become involved with such work. So far, I have been given the opportunity to participate in projects resulting from a congressional request, several bankcard reconciliations, updating routing lists for Travel Manager, updating the majordomo list for Travel Manager approvers and point of contacts, and a NASA Headquarters project involving

National Aeronautics and Space Administration — The Exploration Medical Capability (ExMC) Element of NASA's Human Research Program (HRP) developed the IntegratedMedical Model (IMM) to forecast the resources...

People with cancer may face major financial challenges and need help dealing with the high costs of care. Cancer treatment can be very expensive, even when you have insurance. Learn ways to managemedical information, paperwork, bills, and other records.

In response to the RCRA land ban regulations and TC rule promulgated by the U.S. Federal Environmental Protection Agency (EPA) in 1988-1990, an Integrated Refinery Waste Management (IRWM) program has been developed to provide cost-effective solutions to petroleum industry customers. The goal of IRWM is to provide technology based remediation treatment services to manage sludges and wastewaters generated from the oil refining processes, soils contaminated with petroleum distillates and groundwater contaminated with fuels. Resource recovery, volume reduction and waste minimization are the primary choices to mitigate environmental problems. Oil recovery has been performed through phase separation (such as centrifugation and filtration) and heating of heavy oils. Volume reduction is achieved by dewatering systems such as centrifuges and filter presses, and low temperature thermal treatment. Waste minimization can be accomplished by bioremediation and resource recovery through a cement kiln. (Author).

Medical Information Management System (MIMS) computer program interactive, general-purpose software system for storage and retrieval of information. Offers immediate assistance where manipulation of large data bases required. User quickly and efficiently extracts, displays, and analyzes data. Used in management of medical data and handling all aspects of data related to care of patients. Other applications include management of data on occupational safety in public and private sectors, handling judicial information, systemizing purchasing and procurement systems, and analyses of cost structures of organizations. Written in Microsoft FORTRAN 77.

The rapid advancements in high performance global communication have accelerated cooperative image-based medical services to a new frontier. Traditional image-based medical services such as radiology and diagnostic consultation can now fully utilize multimedia technologies in order to provide novel services, including remote cooperative medical triage, distributed virtual simulation of operations, as well as cross-country collaborative medical research and training. Fast (efficient) and easy (flexible) retrieval of relevant images remains a critical requirement for the provision of remote medical services. This paper describes the database system requirements, identifies technological building blocks for meeting the requirements, and presents a system architecture for our target image database system, MISSION-DBS, which has been designed to fulfill the goals of Project MISSION (medical imaging support via satellite integrated optical network) -- an experimental high performance gigabit satellite communication network with access to remote supercomputing power, medical image databases, and 3D visualization capabilities in addition to medical expertise anywhere and anytime around the country. The MISSION-DBS design employs a synergistic fusion of techniques in distributed databases (DDB) and artificial intelligence (AI) for storing, migrating, accessing, and exploring images. The efficient storage and retrieval of voluminous image information is achieved by integrating DDB modeling and AI techniques for image processing while the flexible retrieval mechanisms are accomplished by combining attribute- based and content-based retrievals.

Full Text Available This article sets out to increase awareness regarding the wide and universal significance of disability, as well as the important benefits of an Integrated Disability Management (IDM approach. The scientific basis for IDM is explored in the first place through an analysis of its relationship to the International Classification of Functioning, Disability and Health (ICF. The conceptual paradigm of the ICF shares an ideological position with the IDM approach in that they are both underpinned by dynamic and multidimensional constructions of disability, which imply equally holistic and interdisciplinary responses. The IDM approach can be applied across a diversity of human situations to provide solutions that reflect the multifaceted and widespread nature of disability. The IDM approach is intended as a strategy capable of handling: inclusion of people with disabilities, active aging of human resources, health and safety in the workplace, prevention of disabilities and various diseases, return-to-work, absenteeism, and presenteeism.

Integrated supply chain risk management (ISCRM) has become indispensable to the theory and practice of supply chain management. The economic and political realities of the modern world require not only a different approach to supply chain management, but also bold steps to secure supply chain performance and sustainable wealth creation. Integrated supply chain risk management provides supply chain organisations with a level of insight into their supply chains yet to be achieved. If correctly ...

submitted CP to IRB  Documented UAT and EFT results  Completed Clinical Review (CR) and sign off for Patient and Provider Use  Note: The project...management, the “high- attention” call-center based services, are tapping into every avenue available to determine how to raise engagement rates from

An effective Integrated Pest Management (IPM) programme requires a thorough knowledge of the biology of the target species, namely information on the dispersal, population densities and dynamics as well as the ecology of the natural enemies of the pest. Studies on these can be accomplished by radiolabelling techniques. In the event that conditions prevent the use of radioisotopes the insects can be labelled with either a rare earth or stable isotopes. All insects treated with the rare earths, once captured, are exposed to neutrons which produce radioactivity in the rare earths. There are two other approaches in the practical application of radiation to the problem of insect control: the exposure of insects to lethal doses of radiation and the release of sterile insects. The Insect and Pest Control Section contributes to all aspects of the sterile insect technique (SIT) and it is involved in the Agency's Coordinated Research Programme which permits scientists from the developing countries to meet to discuss agricultural problems and to devise means of solving crop-pest infestation problems by using isotopes and radiation. The success of radiation in insect pest control was underlined and reviewed at the international symposium on the sterile insect technique and the use of radiation in genetic insect control jointly organized by the FAO and the IAEA and held in the FRG in 1981. Another important action is the BICOT programme in Nigeria between the IAEA and the Government of Nigeria on the biological control of tsetse flies by SIT

Several projects have shown that self-management of medication in private homes can be challenging. Many projects focused on specific illness-related approaches (e.g. diabetes) or practical issues such as how to handle medication while travelling. However, designing for everyday medicationmanage....... These medication particularities can enhance the individual’s medication overview and support the understanding of medication intake in everyday life. The study also presents five design principles for future design of PHMMS....

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for optimizing costs of ownership of all equipment. Clinical engineers can identify technological solutions based on the matching of new medical equipment with hospital's objectives. They can review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with cost accounting analysis, will objectively guide the capital assets decision-making process. Cost accounting analysis is a multivariate function that includes determining the amount, based upon a strategic plan and financial resources, of funding to be allocated annually for medical equipment acquisition and replacement. Often this function works closely with clinical engineering to establish equipment useful life and prioritization of acquisition, upgrade, and replacement of inventory within budget confines and without conducting time consuming, individual financial capital project evaluations.

We present a novel management methodology for restocking a declining population. The strategy uses integral control, a concept ubiquitous in control theory which has not been applied to population dynamics. Integral control is based on dynamic feedback-using measurements of the population to inform management strategies and is robust to model uncertainty, an important consideration for ecological models. We demonstrate from first principles why such an approach to population management is suitable via theory and examples.

Information Technology is the core capability required to align our resources and increase our effectiveness on the battlefield by integrating and coordinating our preventative measures and responses...

The burgeoning of medical sociology has sometimes been accompanied by unfortunate parochialism and the presence of opposing intellectual camps that ignore and even impugn each other's work. We have lost opportunities to achieve creative discourse and integration of different perspectives, methods, and findings. At this stage we should consider how we can foster creative integration within our field.

Full Text Available Integrated supply chain risk management (ISCRM has become indispensable to the theory and practice of supply chain management. The economic and political realities of the modern world require not only a different approach to supply chain management, but also bold steps to secure supply chain performance and sustainable wealth creation. Integrated supply chain risk management provides supply chain organisations with a level of insight into their supply chains yet to be achieved. If correctly applied, this process may optimise management decision-making and assist in the protection and enhancement of shareholder value.

This review deals specifically with the medicalmanagement of victims, such as, the triage of exposed individuals on the basis of preliminary observations and investigations, planning priority of treatment to different groups, emergency care, and definitive care. The infrastructure for appropriate management involves first aid posts, decontamination centre, Site Hospital and Specialized Central Hospital. Medicalmanagement of life threatening radiation doses involve haematological examinations, blood component therapy, treatment with growth factors and if necessary, bone marrow transplantation as the last option. Most of the radiation accidents involving partial body and localized exposures are associated with industrial radiography sources. Such exposures are generally not life threatening but may involve serious skin injury, such as, ulceration, necrosis and gangrene. Methods have been developed to carry out decontamination of skin and decorporation of internally deposited radio nuclides. This article also provides information on the Radiation Emergency Medical Preparedness and Assistance Network and also outlines the role of media in reducing the human suffering in the event of an accident

The report presents the results of a feasibility study on an integrated data organisation and management in RODOS, the real-time on-line decision support system for off-site nuclear emergency management. The conceptual design of the functional components of the integrated data management are described taking account of the software components and the operation environment of the RODOS system. In particular, the scheme architecture of a database integrationmanager for accessing and updating a multi-database system is discussed in detail under a variety of database management aspects. Furthermore, the structural design of both a simple knowledge database and a real-time database are described. Finally, some short comments on the benefits and disadvantages of the proposed concept of data integration in RODOS are given. (orig.) [de

National Aeronautics and Space Administration — Abstract: Building health management is an important part in running an efficient and cost-effective building. Many problems in a building’s system can go undetected...

Full Text Available Integrating a mechanism to store, retrieve and use clinical data with a system to managemedical records enables better utilisation of medical data and improved healthcare. This poster introduces a research project that aims to extend Open...

MIMS, Medical Information Management System is an interactive, general purpose information storage and retrieval system. It was first designed to be used in medical data management, and can be used to handle all aspects of data related to patient care. Other areas of application for MIMS include: managing occupational safety data in the public and private sectors; handling judicial information where speed and accuracy are high priorities; systemizing purchasing and procurement systems; and analyzing organizational cost structures. Because of its free format design, MIMS can offer immediate assistance where manipulation of large data bases is required. File structures, data categories, field lengths and formats, including alphabetic and/or numeric, are all user defined. The user can quickly and efficiently extract, display, and analyze the data. Three means of extracting data are provided: certain short items of information, such as social security numbers, can be used to uniquely identify each record for quick access; records can be selected which match conditions defined by the user; and specific categories of data can be selected. Data may be displayed and analyzed in several ways which include: generating tabular information assembled from comparison of all the records on the system; generating statistical information on numeric data such as means, standard deviations and standard errors; and displaying formatted listings of output data. The MIMS program is written in Microsoft FORTRAN-77. It was designed to operate on IBM Personal Computers and compatibles running under PC or MS DOS 2.00 or higher. MIMS was developed in 1987.

Adverse drug events resulting from errors in prescribing or administering medications are preventable. Within a hospital system, numerous technologies are employed to address the common sources of medication error, including the use of electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. Infusion safety is inherently risky because of the high-risk medications administered and the lack of integration among the stand-alone systems in most institutions. Intravenous clinical integration (IVCI) is a technology that connects electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. It combines the safety features of an automatically programmed infusion pump (drug, concentration, infusion rate, and patient weight, all auto-programmed into the device) with software that provides visibility to real-time clinical infusion data. Our article describes the characteristics of IVCI at WellSpan Health and its impact on patient safety. The integrated infusion system has the capability of reducing medication errors, improving patient care, reducing in-facility costs, and supporting asset management. It can enhance continuous quality improvement efforts and efficiency of clinical work flow. After implementing IVCI, the institution realized a safer patient environment and a more streamlined work flow for pharmacy and nursing.

this by the case of how the concept of 'medicationmanagement' has been performed differently on a combined CSCW and participatory design project in healthcare. It is suggested that through design interventions with working prototypes; prospective analysis and participatory design can be fruitfully assembled...... of creating a better understanding or description of the user. Inspired by later developments in Science and Technology Studies I engage an ontological reconceptualization and turn to consider and practice the relation as performative - thus making ethnography, design and users' practices converge. I show...

Sustainable water management is a key environmental challenge of the 21st century. Developing and implementing innovative management approaches and how to cope with the increasing complexity and uncertainties was the theme of the first International Conference on Adaptive and Integrated Water

The relevance of management as significant factor of business activity can be established on various management systems. These will help to obtain, organise, administrate, evaluate and control particulars: information, quality, environmental protection, health and safety, various resources (time, human, finance, inventory etc). The complexity of nowadays days development, forced us to think â€˜integratedâ€™. Sustainable development principles require that environment management policies and p...

In the era of the biological-psychological-social medicine model, an ideal of modern medicine is to enhance the humanities in medical education, to foster medical talents with humanistic spirit, and to promote the integration of scientific spirit and humanistic spirit in medicine. Throughout the United States (US), United Kingdom (UK), other Western countries, and some Asian countries like Japan, many medical universities have already integrated the learning of medical humanities in their curricula and recognized their value. While in China, although medical education reform over the past decade has emphasized the topic of medical humanities to increase the professionalism of future physicians, the integration of medical humanity courses in medical universities has lagged behind the pace in Western countries. In addition, current courses in medical humanities were arbitrarily established due to a lack of organizational independence. For various reasons like a shortage of instructors, medical universities have failed to pay sufficient attention to medical humanities education given the urgent needs of society. The medical problems in contemporary Chinese society are not solely the purview of biomedical technology; what matters more is enhancing the humanities in medical education and fostering medical talents with humanistic spirit. Emphasizing the humanities in medical education and promoting the integration of medical scientific spirit and medical humanistic spirit have become one of the most pressing issues China must address. Greater attention should be paid to reasonable integration of humanities into the medical curriculum, creation of medical courses related to humanities and optimization of the curriculum, and actively allocating abundant teaching resources and exploring better methods of instruction.

Especially for investigator-initiated research at universities and academic institutions, Internet-based rare disease registries (RDR) are required that integrate electronic data capture (EDC) with automatic image analysis or manual image annotation. We propose a modular framework merging alpha-numerical and binary data capture. In concordance with the Office of Rare Diseases Research recommendations, a requirement analysis was performed based on several RDR databases currently hosted at Uniklinik RWTH Aachen, Germany. With respect to the study management tool that is already successfully operating at the Clinical Trial Center Aachen, the Google Web Toolkit was chosen with Hibernate and Gilead connecting a MySQL database management system. Image and signal data integration and processing is supported by Apache Commons FileUpload-Library and ImageJ-based Java code, respectively. As a proof of concept, the framework is instantiated to the German Calciphylaxis Registry. The framework is composed of five mandatory core modules: (1) Data Core, (2) EDC, (3) Access Control, (4) Audit Trail, and (5) Terminology as well as six optional modules: (6) Binary Large Object (BLOB), (7) BLOB Analysis, (8) Standard Operation Procedure, (9) Communication, (10) Pseudonymization, and (11) Biorepository. Modules 1-7 are implemented in the German Calciphylaxis Registry. The proposed RDR framework is easily instantiated and directly integrates image management and analysis. As open source software, it may assist improved data collection and analysis of rare diseases in near future.

The Uranium Mill Tailings Remedial Action (UMTRA) Project is a Department of Energy (DOE) designated Major System Acquisition (MSA). To execute and manage the Project mission successfully and to comply with the MSA requirements, the UMTRA Project Office (''Project Office'') has implemented and operates an Integrated Project Management System (IPMS). The Project Office is assisted by the Technical Assistance Contractor's (TAC) Project Integration and Control (PIC) Group in system operation. Each participant, in turn, provides critical input to system operation and reporting requirements. The IPMS provides a uniform structured approach for integrating the work of Project participants. It serves as a tool for planning and control, workload management, performance measurement, and specialized reporting within a standardized format. This system description presents the guidance for its operation. Appendices 1 and 2 contain definitions of commonly used terms and abbreviations and acronyms, respectively. 17 figs., 5 tabs

Full Text Available The aim of this paper is to present a Knowledge Management System based on Fuzzy Logic (FLKMS, a real-time expert system to meet the challenges of the dynamic environment. The main feature of our integrated shell FLKMS is that it models and integrates the temporal relationships between the dynamic of the evolution of an economic process with some fuzzy inferential methods, using a knowledge model for control, embedded within the expert system’s operational knowledge base.

Successful medicalmanagement of otitis externa requires attention to all of the following points: 1. Diagnose and treat systemic or underlying disease(s). 2. Carefully clean and examine the entire ear canal before starting therapy. This includes removal of foreign bodies, parasites, hair, and other obstructions. 3. Apply carefully chosen topical preparations based on gross and microscopic examination. 4. Educate clients as to the causes of the otitis externa and their role in treating the disease. 5. Schedule regular follow-up examinations until the disease is completely cured. 6. Recommend preventive procedures such as drying ears after swimming, corrective surgery, and so on. 7. Use systemic treatment when indicated by chronicity of disease or the owner's inability to treat the patient.

The basic features of integrated urban water quality management by means of deterministic modeling are outlined. Procedures for the assessment of the detrimental effects in the recipient are presented as well as the basic concepts of an integrated model. The analysis of a synthetic urban drainage...... system provides useful information for water quality management. It is possible to identify the system parameters that contain engineering significance. Continuous simulation of the system performance indicates that the combined nitrogen loading is dominated by the wastewater treatment plant during dry...

The concept of integrated project management represents a single source to which the owner can turn for all project management functions excepting for those relating to outside parties such as site purchase, personnel selection etc. Other functions such as design, procurement, construction management, schedule and cost control, quality assurance/quality control are usually handled by the integrated project manager as the agent of the owner. The arrangement is flexible and the responsibilities can be varied to suit the size and experience of the owner. Past experience in the United States indicates an increase in the trend toward IPM work and it appears that overseas this trend is developing also. (orig./RW) [de

Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina. Until recent, the site was split in Atucha I NPP, a 350 MW pressure vessel heavy water reactor in operation since 1974; and Atucha II, a similar design reactor, twice as big as Atucha I finishing a delayed construction. With the start-up of Atucha II and aiming to integrate the management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) has reorganized its operation units. Within this reorganization, an Ageing Management Department has been created to cope with all ageing issues of both Atucha I and II units. The Atomic Energy Commission of Argentina (Comision Nacional de Energia Atomica - CNEA) is a state-owned R and D organization that; among other functions such as designing and building research reactors, developing uranium mining and supplying radioisotopes to the medical market; is in charge of providing support and technological update to all Argentinean NPPs. The Ageing Management Department of Atucha NPP and the Ageing Management Division of CNEA has formed a joint working group in order to set up an Integrated Ageing Management Program for Atucha NPP following IAEA guidelines. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented. (author)

Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina. Until recent, the site was split in Atucha I NPP, a 350 MW pressure vessel heavy water reactor in operation since 1974; and Atucha II, a similar design reactor twice as big as Atucha I finishing a delayed construction . With the start-up of Atucha II and aiming to integrate the management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) has reorganized its operation units. Within this reorganization, an Ageing Management Department has been created to cope with all ageing issues of both Atucha I and II units. The Atomic Energy Commission of Argentina (Comision Nacional de Energia Atomica - CNEA) is a state-owned R and D organization that; among other functions such as designing and building research reactors, developing uranium mining and supplying radioisotopes to the medical market; is in charge of providing support and technological update to all Argentinean NPPs. The Ageing Management Department of Atucha NPP and the Ageing Management Division of CNEA has formed a joint working group in order to set up an Integrated Ageing Management Program for Atucha NPP following IAEA guidelines. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented. (author)

Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina. Until recent, the site was split in Atucha I NPP, a 350 MW pressure vessel heavy water reactor in operation since 1974; and Atucha II, a similar design reactor, twice as big as Atucha I finishing a delayed construction. With the start-up of Atucha II and aiming to integrate the management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) has reorganized its operation units. Within this reorganization, an Ageing Management Department has been created to cope with all ageing issues of both Atucha I and II units. The Atomic Energy Commission of Argentina (Comision Nacional de Energia Atomica - CNEA) is a state-owned R and D organization that; among other functions such as designing and building research reactors, developing uranium mining and supplying radioisotopes to the medical market; is in charge of providing support and technological update to all Argentinean NPPs. The Ageing Management Department of Atucha NPP and the Ageing Management Division of CNEA has formed a joint working group in order to set up an Integrated Ageing Management Program for Atucha NPP following IAEA guidelines. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented. (author)

Empirical research has focused on export as a proxy for the exchange rate exposure and the use of foreign exchange derivatives as the instrument to deal with this exposure. This empirical study applies an integrated foreign exchange risk management approach with a particular focus on the role...

In present day exist quality assurance system, environment, occupational health and safety such as ISO9001, ISO14001 and OHSAS18001 and others standards will can create. These standards can be implemented and certified they guarantee one record system, quality assurance, documents control, operational control, responsibility definition, training, preparing and serve to emergency, monitoring, internal audit, corrective action, continual improvement, prevent of pollution, write procedure, reduce costs, impact assessment, risk assessment , standard, decree, legal requirements of municipal, state, federal and local scope. These procedure and systems when isolate applied cause many management systems and bureaucracy. IntegrationManagement System reduce to bureaucracy, excess of documents, documents storage and conflict documents and easy to others standards implementation in future. The IntegratedManagement System (IMS) will be implemented in 2007. INB created a management group for implementation, this group decides planing, works, policy and advertisement. Legal requirements were surveyed, internal audits, pre-audits and audits were realized. INB is partially in accordance with ISO14001, OSHAS18001 standards. But very soon, it will be totally in accordance with this norms. Many studies and works were contracted to deal with legal requirements. This work have intention of show implementation process of ISO14001, OHSAS18001 and IntegratedManagement System on INB. (author)

At present, hospitals in our country have basically established the HIS system, which manages registration, treatment, and charge, among many others, of patients. During treatment, patients need to use medical devices repeatedly to acquire all sorts of inspection data. Currently, the output data of the medical devices are often manually input into information system, which is easy to get wrong or easy to cause mismatches between inspection reports and patients. For some small hospitals of which information construction is still relatively weak, the information generated by the devices is still presented in the form of paper reports. When doctors or patients want to have access to the data at a given time again, they can only look at the paper files. Data integration between medical devices has long been a difficult problem for the medical information system, because the data from medical devices are lack of mandatory unified global standards and have outstanding heterogeneity of devices. In order to protect their own interests, manufacturers use special protocols, etc., thus causing medical decices to still be the "lonely island" of hospital information system. Besides, unfocused application of the data will lead to failure to achieve a reasonable distribution of medical resources. With the deepening of IT construction in hospitals, medical information systems will be bound to develop towards mobile applications, intelligent analysis, and interconnection and interworking, on the premise that there is an effective medical device integration (MDI) technology. To this end, this paper presents a MDI model based on the Internet of Things (IoT). Through abstract classification, this model is able to extract the common characteristics of the devices, resolve the heterogeneous differences between them, and employ a unified protocol to integrate data between devices. And by the IoT technology, it realizes interconnection network of devices and conducts associate matching

PURPOSE: The aim of this review was to provide current best evidence for evaluation, dietary, and medicalmanagement of patients with urolithiasis. METHODS: Literature addressing evaluation, dietary, and medicalmanagement of urolithiasis was searched. Papers were analyzed and rated according...... the life of stone-forming individuals very differently, and that evaluation and medicalmanagement should be personalized according to risk of recurrence, severity of stone disease, presence of associated medical conditions, and patient's motivation. With regard to evaluation, dietary and medical...... management of patients with urolithiasis evidence from the literature suggest that selective metabolic evaluation may lead to rational dietary and medicalmanagement. Statements based on LOE and GOR are provided to guide clinical practice. CONCLUSION: The provided evidence for evaluation of patients...

Medical equipments are essential supplies to carry out medical work. How to ensure the safety and reliability of the medical equipments in diagnosis, and reduce procurement and maintenance costs is a topic of concern to everyone. In this paper, product lifecycle management (PLM) and enterprise resource planning (ERP) are cited to establish a lifecycle management information system. Through integrative and analysis of the various stages of the relevant data in life-cycle, it can ensure safety and reliability of medical equipments in the operation and provide the convincing data for meticulous management.

Medical imaging is increasing its importance in matters of medical diagnosis and in treatment support. Much is due to computers that have revolutionized medical imaging not only in acquisition process but also in the way it is visualized, stored, exchanged and managed. Picture Archiving and Communication Systems (PACS) is an example of how medical imaging takes advantage of computers. To solve problems of interoperability of PACS and medical imaging equipment, the Digital Imaging and Communications in Medicine (DICOM) standard was defined and widely implemented in current solutions. More recently, the need to exchange medical data between distinct institutions resulted in Integrating the Healthcare Enterprise (IHE) initiative that contains a content profile especially conceived for medical imaging exchange: Cross Enterprise Document Sharing for imaging (XDS-i). Moreover, due to application requirements, many solutions developed private networks to support their services. For instance, some applications support enhanced query and retrieve over DICOM objects metadata. This paper proposes anintegration framework to medical imaging networks that provides protocols interoperability and data federation services. It is an extensible plugin system that supports standard approaches (DICOM and XDS-I), but is also capable of supporting private protocols. The framework is being used in the Dicoogle Open Source PACS.

Full Text Available For manufacturing companies to succeed in today's unstable economic environment, it is necessary to restructure the main components of its activities: designing innovative product, production using modern reconfigurable manufacturing systems, a business model that takes into account the global strategy and management methods using modern management models and tools. The first three components are discussed in numerous publications, for example, (Koren, 2010 and is therefore not considered in the article. A large number of publications devoted to the methods and tools of production management, for example (Halevi, 2007. On the basis of what was said in the article discusses the possibility of the integration of only three methods have received in recent years, the most widely used, namely: Six Sigma method - SS (George et al., 2005 and supplements its-Design for six sigm? - DFSS (Taguchi, 2003; Lean production transformed with the development to the "Lean management" and further to the "Lean thinking" - Lean (Hirano et al., 2006; Theory of Constraints, developed E.Goldratt - TOC (Dettmer, 2001. The article investigates some aspects of this integration: applications in diverse fields, positive features, changes in management structure, etc.

Medical consumables material is essential supplies to carry out medical work, which has a wide range of varieties and a large amount of usage. How to manage it feasibly and efficiently that has been a topic of concern to everyone. This article discussed about how to design a medical consumable material management information system that has a set of standardized processes, bring together medical supplies administrator, suppliers and clinical departments. Advanced management mode, enterprise resource planning (ERP) applied to the whole system design process.

One of the problems in the building industry is a limited degree of learning from experiences of use and operation of existing buildings. Development of professional facilities management (FM) can be seen as the missing link to bridge the gap between building operation and building design....... Strategies, methods and barriers for the transfer and integration of operational knowledge into the design process are discussed. Multiple strategies are needed to improve the integration of FM in design. Building clients must take on a leading role in defining and setting up requirements and procedures...... on literature studies and case studies from the Nordic countries in Europe, including research reflections on experiences from a main case study, where the author, before becoming a university researcher, was engaged in the client organization as deputy project director with responsibility for the integration...

The Daniel K. Inouye Solar Telescope (DKIST) Observatory is under construction at Haleakalā, Maui, Hawai'i. When complete, the DKIST will be the largest solar telescope in the world. The Facility Management System (FMS) is a subsystem of the high-level Facility Control System (FCS) and directly controls the Facility Thermal System (FTS). The FMS receives operational mode information from the FCS while making process data available to the FCS and includes hardware and software to integrate and control all aspects of the FTS including the Carousel Cooling System, the Telescope Chamber Environmental Control Systems, and the Temperature Monitoring System. In addition it will integrate the Power Energy Management System and several service systems such as heating, ventilation, and air conditioning (HVAC), the Domestic Water Distribution System, and the Vacuum System. All of these subsystems must operate in coordination to provide the best possible observing conditions and overall building management. Further, the FMS must actively react to varying weather conditions and observational requirements. The physical impact of the facility must not interfere with neighboring installations while operating in a very environmentally and culturally sensitive area. The FMS system will be comprised of five Programmable Automation Controllers (PACs). We present a pre-build overview of the functional plan to integrate all of the FMS subsystems.

This paper is a discussion of an emerging concept for improving nuclear plant outage performance - integrated outage management. The paper begins with an explanation of what the concept encompasses, including a scope definition of the service and descriptions of the organization structure, various team functions, and vendor/customer relationships. The evolvement of traditional base scope services to the integrated outage concept is addressed and includes discussions on changing customer needs, shared risks, and a partnership approach to outages. Experiences with concept implementation from a single service in 1984 to the current volume of integrated outage management presented in this paper. We at Westinghouse believe that the operators of nuclear power plants will continue to be aggressively challenged in the next decade to improve the operating and financial performance of their units. More and more customers in the U. S. are looking towards integrated outage as the way to meet these challenges of the 1990s, an arrangement that is best implemented through a long-term partnering with a single-source supplier of high quality nuclear and turbine generator outage services. This availability, and other important parameters

Full Text Available Complementary WLAN and WPAN technologies as well as other wireless technologies will play a fundamental role in the medical environments to support ubiquitous healthcare delivery. This paper investigates clear channel assessment (CCA and its impact on the coexistence of WLAN (IEEE 802.11 high rate direct sequence spread spectrum (HR/DSSS PHY and WPAN (IEEE 802.15.4b in the 2.4Ã¢Â€Â‰GHz industrial, scientific, and medical (ISM band. We derived closed-form expressions of both energy-based CCA and feature-based CCA. We qualified unequal sensing abilities between them and termed this inequality asymmetric CCA, which is different from the traditional Ã¢Â€Âœhidden nodeÃ¢Â€Â or Ã¢Â€Âœexposed nodeÃ¢Â€Â issues in the homogeneous network. The energy-based CCA was considered in the considered integratedmedical environment because the 2.4Ã¢Â€Â‰GHz ISM band is too crowded to apply feature-based CCA. The WPAN is oversensitive to the 802.11 HR/DSSS signals and the WLAN is insensitive to the 802.15.4b signals. Choosing an optimal CCA threshold requires some prior knowledge of the underlying signals. In the integratedmedical environment we considered here, energy-based CCA can effectively avoid possible packet collisions when they are close within the Ã¢Â€Âœheterogeneous exclusive CCA rangeÃ¢Â€Â (HECR. However, when they are separated beyond the HECR, WPAN can still sense the 802.11 HR/DSSS signals, but WLAN loses its sense to the 802.15.4b signals. The asymmetric CCA leads to WPAN traffic in a position secondary to WLAN traffic.

Full Text Available Abstract Complementary WLAN and WPAN technologies as well as other wireless technologies will play a fundamental role in the medical environments to support ubiquitous healthcare delivery. This paper investigates clear channel assessment (CCA and its impact on the coexistence of WLAN (IEEE 802.11 high rate direct sequence spread spectrum (HR/DSSS PHY and WPAN (IEEE 802.15.4b in the 2.4 GHz industrial, scientific, and medical (ISM band. We derived closed-form expressions of both energy-based CCA and feature-based CCA. We qualified unequal sensing abilities between them and termed this inequality asymmetric CCA, which is different from the traditional "hidden node" or "exposed node" issues in the homogeneous network. The energy-based CCA was considered in the considered integratedmedical environment because the 2.4 GHz ISM band is too crowded to apply feature-based CCA. The WPAN is oversensitive to the 802.11 HR/DSSS signals and the WLAN is insensitive to the 802.15.4b signals. Choosing an optimal CCA threshold requires some prior knowledge of the underlying signals. In the integratedmedical environment we considered here, energy-based CCA can effectively avoid possible packet collisions when they are close within the "heterogeneous exclusive CCA range" (HECR. However, when they are separated beyond the HECR, WPAN can still sense the 802.11 HR/DSSS signals, but WLAN loses its sense to the 802.15.4b signals. The asymmetric CCA leads to WPAN traffic in a position secondary to WLAN traffic.

Full Text Available The relevance of management as significant factor of business activity can be established on various management systems. These will help to obtain, organise, administrate, evaluate and control particulars: information, quality, environmental protection, health and safety, various resources (time, human, finance, inventory etc. The complexity of nowadays days development, forced us to think â€˜integratedâ€™. Sustainable development principles require that environment management policies and practices are not good in themselves but also integrate with all other environmental objectives, and with social and economic development objectives. The principles of sustainable development involve that environment management policies and practices. These are not sound in them-self but also integrate with all other environmental objectives, and with social and economic development objectives. Those objectives were realized, and followed by development of strategies to effects the objective of sustainable development. Environmental management should embrace recent change in the area of environmental protection, and suit the recently regulations of the field -entire legal and economic, as well as perform management systems to meet the requirements of the contemporary model for economic development. These changes are trailed by abandon the conventional approach of environmental protection and it is replaced by sustainable development (SD. The keys and the aims of Cleaner Productions (CP are presented being implemented in various companies as a non-formalised environmental management system (EMS. This concept is suggested here as a proper model for practice where possible environmental harmful technologies are used -e.g. Rosia Montana. Showing the features and the power of CP this paper is a signal oriented to involve the awareness of policy-makers and top management of diverse Romanian companies. Many companies in European countries are developing

Mode management is the processes of understanding the character and consequences of autoflight modes, planning and selecting the engagement, disengagement and transitions between modes, and anticipating automatic mode transitions made by the autoflight system itself. The state of the art is represented by the latest designs produced by each of the major airframe manufacturers, the Boeing 747-400, the Boeing 777, the McDonnell Douglas MD-11, and the Airbus A320/A340 family of airplanes. In these airplanes autoflight modes are selected by manipulating switches on the control panel. The state of the autoflight system is displayed on the flight mode annunciators. The integrated mode management interface (IMMI) is a graphical interface to autoflight mode management systems for aircraft equipped with flight management computer systems (FMCS). The interface consists of a vertical mode manager and a lateral mode manager. Autoflight modes are depicted by icons on a graphical display. Mode selection is accomplished by touching (or mousing) the appropriate icon. The IMMI provides flight crews with an integrated interface to autoflight systems for aircraft equipped with flight management computer systems (FMCS). The current version is modeled on the Boeing glass-cockpit airplanes (747-400, 757/767). It runs on the SGI Indigo workstation. A working prototype of this graphics-based crew interface to the autoflight mode management tasks of glass cockpit airplanes has been installed in the Advanced Concepts Flight Simulator of the CSSRF of NASA Ames Research Center. This IMMI replaces the devices in FMCS equipped airplanes currently known as mode control panel (Boeing), flight guidance control panel (McDonnell Douglas), and flight control unit (Airbus). It also augments the functions of the flight mode annunciators. All glass cockpit airplanes are sufficiently similar that the IMMI could be tailored to the mode management system of any modern cockpit. The IMMI does not replace the

The role of biomedical engineers (BMEs) has changed widely over the years, from managing a group of technicians to the planning of large installations and the management of medical technology countrywide. As the technology has advanced, the competence of BMEs has been challenged because it is no longer possible to be an expert in every component of the technology involved in running a hospital. Our approach has been to form a network of professionals that are experts in different fields related to medical technology, where work is coordinated to provide high quality services at the planning and execution stages of projects related to medical technology. A study of the procedures involved in the procurement of medical technology has been carried out over the years. These experiences have been compared with several case studies where the approach to problem solving in this area has been multidisciplinary. Planning and execution phases of projects involving medical technology management have been identified. After several instances of collaboration among experts from different fields, a network for management of healthcare technology has been formed at our institution that incorporates the experience from different departments that were dealing separately with projects involving medical technology. This network has led us to propose this approach to solve medical technology management projects, where the strengths of each subgroup complement each other. This structure will lead to a more integrated approach to healthcare technology management and will ensure higher quality solutions.

... pharmacist to help you come up with a coding system for your medications that makes them easier to take. Some pharmacists will prepare blister packs for daily or weekly medications. Make an instruction sheet for yourself by taping a sample of each ...

Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

The development and introduction of emergency measures in Switzerland was mainly characterized by the evaluation of international experience and by systematic analysis of beyond-design basis accidents within the framework of plant-specific probabilistic safety analyses. As early as in the mid-eighties, the Swiss regulatory authority demanded that measures be taken against severe accidents, and periodically added more detailed requirements, most recently in 2000 when the introduction of Severe Accident Management Guidelines (SMAG) was demanded for power operation as well as operation in the non-power mode. The SMAG were introduced at the Goesgen nuclear power station within a project in the period between 2003 and 2005. For this purpose, a concept of integrated emergency management was developed which is based on updates of the proven emergency manual. One important aspect of this integrative concept is the distinction between preventive and mitigating procedures by defining appropriate criteria. The findings made in the implementation phase of the project include the realization that the introduction of procedures dealing with severe accidents also requires the ability to develop new ways of thinking and acting in accident management. This implies the awareness that procedures covering severe accidents must be applied much more flexibly and in the light of the situation than regulations covering fault conditions. Also possibilities to simulate severe accidents were created within the project both for the development of procedures and for training plant operators and members of the emergency staff. (orig.)

The advent of integration as a feature of contemporary medical curricula can be seen as an advantage for the medical humanities in that it provides a clear implementation strategy for the inclusion of medical humanities content and/or perspectives, while also making its relevance to medical education more apparent. This paper discusses an example of integration of humanities content into a graduate medical course, raises questions about the desirability of an exclusively integrated approach, and argues for the value of retaining a discrete and coherent disciplinary presence for the medical humanities in medical curricula.

Full Text Available Monica Zolezzi Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar Abstract: Electroconvulsive therapy (ECT has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. Keywords: ECT, medications, drug interactions

The integration of health and safety, environmental and quality (HSEQ) management systems has become a current topic in the 21st century, as the need for systems thinking has grown along with the number of management system standards. This study aims to map current developments and trends in integrated HSEQ management. Three viewpoints are taken: the current state of the main HSEQ management standards, research literature on integratedmanagement systems (IMS), and a case study of an industry...

For timely, accurate and flexible access to medical expenses data, we applied Microsoft Access 2003 database management software, and we finished the establishment of a management platform for medical expenses. By developing management platform for medical expenses, overall hospital costs for medical expenses can be controlled to achieve a real-time monitoring of medical expenses. Using the Access database management platform for medical expenses not only changes the management model, but also promotes a sound management system for medical expenses. (authors)

In this paper, we present an integratedmanagement system for radioactive waste, which can keep watch on the whole transporting process of each drum from nuclear power plant temporary storage house to radioactive waste storage house remotely. Our approach use RFID(Radio Frequency Identification) system, which can recognize the data information without touch, GSP system, which can calculate the current position precisely using the accurate time and distance measured from satellites, and the spread spectrum technology CDMA, which is widely used in the area of mobile communication.

In this paper, we present an integratedmanagement system for radioactive waste, which can keep watch on the whole transporting process of each drum from nuclear power plant temporary storage house to radioactive waste storage house remotely. Our approach use RFID(Radio Frequency Identification) system, which can recognize the data information without touch, GSP system, which can calculate the current position precisely using the accurate time and distance measured from satellites, and the spread spectrum technology CDMA, which is widely used in the area of mobile communication

This document is the distribution integritymanagement plan (Plan) for the Los Alamos National Laboratory (LANL) Natural Gas Distribution System. This Plan meets the requirements of 49 CFR Part 192, Subpart P Distribution IntegrityManagement Programs (DIMP) for the LANL Natural Gas Distribution System. This Plan was developed by reviewing records and interviewing LANL personnel. The records consist of the design, construction, operation and maintenance for the LANL Natural Gas Distribution System. The records system for the LANL Natural Gas Distribution System is limited, so the majority of information is based on the judgment of LANL employees; the maintenance crew, the Corrosion Specialist and the Utilities and Infrastructure (UI) Civil Team Leader. The records used in this report are: Pipeline and Hazardous Materials Safety Administration (PHMSA) 7100.1-1, Report of Main and Service Line Inspection, Natural Gas Leak Survey, Gas Leak Response Report, Gas Leak and Repair Report, and Pipe-to-Soil Recordings. The specific elements of knowledge of the infrastructure used to evaluate each threat and prioritize risks are listed in Sections 6 and 7, Threat Evaluation and Risk Prioritization respectively. This Plan addresses additional information needed and a method for gaining that data over time through normal activities. The processes used for the initial assessment of Threat Evaluation and Risk Prioritization are the methods found in the Simple, Handy Risk-based IntegrityManagement Plan (SHRIMP{trademark}) software package developed by the American Pipeline and Gas Agency (APGA) Security and Integrity Foundation (SIF). SHRIMP{trademark} uses an index model developed by the consultants and advisors of the SIF. Threat assessment is performed using questions developed by the Gas Piping Technology Company (GPTC) as modified and added to by the SHRIMP{trademark} advisors. This Plan is required to be reviewed every 5 years to be continually refined and improved. Records

Hospitals have rapidly acquired medical oncology practices in recent years. Experts disagree as to whether these trends are related to oncology-specific market factors or reflect a general trend of hospital-physician integration. The objective of this study was to compare the prevalence, geographic variation, and trends in physicians billing from hospital outpatient departments in medical oncology with other specialties. Retrospective analysis of Medicare claims data for 2012 and 2013. We calculated the proportion of physicians and practitioners in the 15 highest-volume specialties who billed the majority of evaluation and management visits from hospital outpatient departments in each year, nationally and by state. We included 338,998 and 352,321 providers in 2012 and 2013, respectively, of whom 9715 and 9969 were medical oncologists. Among the 15 specialties examined, medical oncology had the highest proportion of hospital outpatient department billing in 2012 and 2013 (35.0% and 38.3%, respectively). Medical oncology also experienced the greatest absolute change (3.3%) between the years, followed by thoracic surgery (2.4%) and cardiology (2.0%). There was marked state-level variation, with the proportion of medical oncologists based in hospital outpatient departments ranging from 0% in Nevada to 100% in Idaho. Hospital-physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends.

Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

Full Text Available Mangrove forest as a renewable resource must be managed based on sustainable basis in which the benefits of ecological, economic and social from the forest have to equity concern in achieving the optimum forest products and services in fulfill the needs of recent generation without destruction of future generation needs and that does not undesirable effects on the physical and social environment. This Sustainable Forest Management (SFM practices needs the supporting of sustainability in the development of social, economic and environment (ecological sounds simultaneously, it should be run by the proper institutional and regulations. In operational scale, SFM need integration in terms of knowledge, technical, consultative of stakeholders, coordination among sectors and other stakeholders, and considerations of ecological inter-relationship in which mangroves as an integral part of both a coastal ecosystem and a watershed (catchment area. Some tools have been developed to measure the performent of SFM, such as initiated by ITTO at 1992 and followed by Ministry of Forestry of Indonesia (1993, CIFOR (1995, LEI (1999, FSC (1999, etc., however, the true nuance of SFM’s performance is not easy to be measured.

Integrated work management (IWM) is the process used for formally implementing the five-step process associated with integrated safety management (ISM) and integrated safeguards and security management (ISSM) at Los Alamos National Laboratory (LANL). IWM also directly supports the LANL Environmental Management System (EMS). IWM helps all workers and managers perform work safely and securely and in a manner that protects people, the environment, property, and the security of the nation. The IWM process applies to all work activities at LANL, from working in the office to designing experiments to assembling and detonating explosives. The primary LANL document that establishes and describes IWM requirements is Procedure (P) 300, Integrated Work Management.

Nuclear Power Plant decommissioning requires a number of demolition activities related to civil works and systems as well as the construction of temporary facilities used for treatment and conditioning of the dismantled parts. The presence of a radiological, potentially hazardous, environment due to the specific configuration and history of the plant require a professional, expert and qualified approach approved by the national safety authority. Dismantling activities must be designed, planned and analysed in detail during an evaluation phase taking into account different scenarios generated by possible dismantling sequences and specific waste treatments to be implemented. The optimisation process of the activities becomes very challenging taking into account the requirement of the minimisation of the radiological impact on exposed workers and people during normal and accident conditions. While remote operated equipment, waste treatment and conditioning facilities may be designed taking into account this primary goal also a centralised management system and corresponding software tools have to be designed and operated in order to guarantee the fulfilment of the imposed limits as well as the traceability of wastes. Ansaldo Nuclear Division has been strongly involved in the development of a qualified and certified software environment to manage the most critical activities of a decommissioning project. The IDMT system (Integrated Decommissioning Management Tools) provide a set of stand alone user friendly applications able to work in an integrated configuration to guarantee waste identification, traceability during treatment and conditioning process as well as location and identification at the Final Repository site. Additionally, the system can be used to identify, analyse and compare different specific operating scenarios to be optimised in term of both economical and radiological considerations. The paper provides an overview of the different phases of

Through the establishment of implantable medical device information management system, with the aid of the regional joint sharing of resources, we further enhance the implantable medical device traceability management level, strengthen quality management, control of medical risk.

Full Text Available The 402–405 MHz medical implant communication service (MICS band has recently been allocated by the US Federal Communication Commission (FCC with the potential to replace the low-frequency inductive coupling techniques in implantable devices. This band was particularly chosen to provide full-integration, low-power, faster data transfer, and longer communication range. This paper investigates the design of a voltage-controlled oscillator (VCO that will be an essential building block of such wireless implantable devices operating in the MICS service band. Three different integrated quadrature VCOs that meet the requirements of the MICS standard are designed in 0.18 μm TSMC CMOS process to propose an optimum choice. Their performances in terms of power consumption, die area, linearity, and phase noise are compared. The fabricated VCOs are a four-stage differential ring VCO, an LC tank VCO directly loaded with a poly-phase filter, and an 800 MHz LC tank VCO with a high-frequency master-slave divider. All three architectures target a VCO gain of Kvco = 15 MHz/V with 3 calibration control and 2 frequency-shift keying (FSK control signals and are designed for 1.5 V supply voltage in a 0.18-μm standard CMOS process.

The Integrated Program Management System (IPMS) Description is a ''working'' document that describes the work processes of the Uranium Mill Tailings Remedial Action Project Office (UMTRA) and IPMS Group. This document has undergone many revisions since the UMTRA Project began; this revision not only updates the work processes but more clearly explains the relationships between the Project Office, contractors, and other participants. The work process flow style has been revised to better describe Project work and the relationships of participants. For each work process, more background and guidance on ''why'' and ''what is expected'' is given. For example, a description of activity data sheets has been added in the work organization and the Project performance and reporting processes, as well as additional detail about the federal budget process and funding management and improved flow charts and explanations of cost and schedule management. A chapter has been added describing the Cost Reduction/Productivity Improvement Program. The Change Control Board (CCB) procedures (Appendix A) have been updated. Project critical issues meeting (PCIM) procedures have been added as Appendix B. Budget risk assessment meeting procedures have been added as Appendix C. These appendices are written to act as stand-alone documentation for each process. As the procedures are improved and updated, the documentation can be updated separately

Aims The aim is to demonstrate the benefit of the medico-ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an ‘integrated therapy safety management’ is drafted. This concept could serve as a basis to improve resilience. Methods The concept is developed through a concept-based approach. The state of the art of safety and complexity research in human factors and ergonomics forms the basis. The findings are synthesized to a concept for ‘integrated therapy safety management’. The concept is applied by way of example for the ‘medication process’ to demonstrate its practical implementation. Results The ‘integrated therapy safety management’ is drafted in accordance with the six layer model. This model supports a detailed description of specific work tasks, the corresponding responsibilities and related workflows at different layers by using the concept of ‘bridge managers’. ‘Bridge managers’ anticipate potential errors and monitor the controlled system continuously. If disruptions or disturbances occur, they respond with corrective actions which ensure that no harm results and they initiate preventive measures for future procedures. The concept demonstrates that in a complex work system, the human factor is the key element and final authority to cope with the residual complexity. The expertise of the ‘bridge managers’ and the recursive hierarchical structure results in highly adaptive clinical work systems and increases their resilience. Conclusions The medico-ergonomic approach is a highly promising way of coping with two complexities. It offers a systematic framework for comprehensive analyses of clinical work systems and promotes interdisciplinary collaboration. PMID:24007448

This report briefly describes the measures to be taken other than ordinary duties when an accident happens in nuclear facilities such as atomic power plant, reprocessing plant, etc. Such nuclear disasters are assigned into four groups; (1) accidents in industrial levels, (2) accidents in which the workers are implicated, (3) accidents of which influence to environments should be taken into consideration and (4) accidents to which measures for inhabitants should be taken. Therefore, the measures to be taken at an emergency were also grouped in the following four; (1) treatments for the accident, itself, (2) measures to minimize the effects on the environment, (3) rescues of the victims and emergency cares for them and (4) measures and medical cares to protect the inhabitants from radiation exposure. Presently, medical professionals, especially doctors, nurses etc. are not accustomed to control nuclear contaminations. Therefore, it is needed for radiological professionals to actively provide appropriate advises about the control and measurement of contamination. (M.N.)

The analysis of alternative fire management programs should be integrated into the land and resource management planning process, but a single fire management analysis model cannot meet all planning needs. Therefore, a set of simulation models that are analytically separate from integrated land management planning models are required. The design of four levels of fire...

The film gives advice on actions to be taken in case of a radiation accident. It addresses involving external irradiation of the whole and partial body, very localized exposure, uptake of radioiodine, inhalation of transuranium elements and a wound of a finger. The film is intended to illustrate the Agency`s Safety Series No. 47 entitled ``Manual on Early Medical Treatment of Possible Radiation Injury`` published in 1978

The Project Management Plan (PMP) assists the San Diego ICM Team by defining a procedural framework for : management and control of the I-15 Integrated Corridor Management Demonstration Project, and development and : deployment of the ICM System. The...

The article discusses a framework for evaluating risk of information technology (IT) integration in acquisitions. Topics include the use of the experience of serial acquirer Trelleborg AB to show the merits of the framework for managing the risk and to determine low-risk acquisitions......, the importance of managing IT integration risk, and various risk areas for acquisition IT integration....

An overview is presented of the use of biomass, with emphasis on peat, as an alternative energy source, from an integrated resource management perspective. Details are provided of the volume of the peat resource, economics of peat harvesting, and constraints to peat resource use, which mainly centre on its high water content. Use of waste heat to dry peat can increase the efficiency of peat burning for electric power generation, and new technologies such as gasification and turbo expanders may also find utilization. The burning or gasification of biomass will release no more carbon dioxide to the atmosphere than other fuels, has less sulfur content than solid fuels. The removal of peat reduces methane emissions and allows use of produced carbon dioxide for horticulture and ash for fertilizer, and creates space that may be used for forestry or agricultural biomass growth. 38 refs

The paper summarizes the results of an experiment conducted on wheat at Kohat, Khyber Pakhtunkhwa, Pakistan during winter 2004-05. Randomized complete block design with split-split-plot arrangement was used where wheat line and broadcast sowing were kept in main plots. Seed rates (100 and 150 kg ha-1) were assigned as sub-plots, while four herbicides (Topik, Isoproturon, Puma super and Buctril super) and weed check were assigned to sub-sub-plots. Results revealed that higher biological yield was recorded in line sowing. However, higher wheat seed rate decreased weed biomass and increased biological yield. Herbicides proved to be effective in decreasing weed biomass and enhancing grain yield and its contributing traits. It was suggested that line sowing in combination with higher seeding rate and Buctril super should be used in an integrated weed management fashion. However further studies are required to investigate various ranges of seeding rate and herbicides doses. (author)

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

This paper aims at presenting a concept of an integrated computer system of management in logistics, particularly in supply and distribution chains. Consequently, the paper includes the basic idea of the concept of computer-based management in logistics and components of the system, such as CAM and CIM systems in production processes, and management systems for storage, materials flow, and for managing transport, forwarding and logistics companies. The platform which integrates computer-aided management systems is that of electronic data interchange.

Full Text Available Medical leadership and management are increasingly receiving widespread attention internationally. Significant focus has been paid as to the style of leadership within healthcare and how to develop both leadership and management skills and competencies (the two are inseparable yet distinct throughout the careers of all healthcare professionals. This article discusses how leadership and management development is being considered internationally, both at an organisational and personal level, helpful models and frameworks and challenges and opportunities.

Financial pressures, an aging population, and a rising number of patients with chronic diseases, have encouraged the use of remote monitoring technologies. This usually entails at least one physiological parameter measurement for a clinician. Mobile telecommunication technologies lend themselves to this functionality, and in some cases, avoid some of the issues encountered with device integration. Moreover, the inherent characteristics of the mobile telecommunications infrastructure allow a coupling of business and clinical functions that were not possible before. Table I compares and contrasts some key aspect of device integration in and out of a healthcare facility. An HTM professional may be part of the team that acquires and/or manages a system using a mobile telecommunications technology. It is important for HTM professionals to ensure the data is in a standard format so that the interfaces across this system don't become brittle and break easily if one part changes. Moreover, the security and safety considerations of the system and the data should be a primary consideration in and y purchase, with attention given to the proper environmental and encryption mechanisms. Clinical engineers and other HTM professionals are unique in that they understand the patient/clinician/device interface and the need to ensure its safety and effectiveness regardless of geographical environment.

Hospitals are producers of small amounts of radioactive waste. Current legislation details exactly how hospitals should manage it. Sealed sources are returned to suppliers. Disposal of unsealed sources, liquid or solid, depends upon their half-life: short-lived radioisotopes (half-life less than two months) are stocked on site while they decay; isotopes with longer half-lives (greater than two months) are handled by a specialist organization (ANDRA). (authors). 8 refs

Full Text Available This paper aims to highlight the links between risk management and quality management and to study the possibility of their integrated approach. The study reviews the evolution of risk approach within organizations and stresses the need to increase the effectiveness of this approach by incorporating risk management methodology in the quality management system. Starting from this idea, the authors present the current state of risk approach into quality management, basic rules of integrated quality-risk management and major difficulties which may arise in the implementation of integrated quality–risk systems.

More than 18,000 patients need medical emergencies management in dental offices in Iran annually. The present study investigates medical emergencies management among Iranian dentists. From the list of the cell phone numbers of the dentists practicing in the city of Tehran, 210 dentists were selected randomly. A self-administered questionnaire was used as the data collection instrument. The questionnaire requested information on personal and professional characteristics of the dentists, as well as their knowledge and self-reported practice in the field of medical emergency management, and availability of required drugs and equipments to managemedical emergencies in their offices. Totally, 177 dentists (84%) completed the questionnaire. Less than 60% of the participants were knowledgeable about characteristics of hypoglycemic patient, chest pain with cardiac origin, and true cardiopulmonary resuscitation (CPR) practice. Regarding practice, less than one quarter of the respondents acquired acceptable scores. In regression models, higher practice scores were significantly associated with higher knowledge scores (p < 0.001). The results call for a need to further education on the subject for dentists. Continuing education and changing dental curriculum in the various forms seems to be useful in enhancement of the self-reported knowledge and practice of dentists. To successful control of medical emergencies in the dental office, dentists must be prepared to recognize and manage a variety of such conditions. In addition to dentist's knowledge and skill, availability of necessary equipments and trained staff is also of critical importance.

Full Text Available Antimycobacterial chemotherapy is the mainstay of treatment for the majority of patients with genitourinary tuberculosis (GUTB. A large body of evidence from clinical trials suggests that short-course chemotherapy regimens, employing four drugs including rifampicin and pyrazinamide, achieve cure in most of the patients with tuberculosis (TB and are associated with the lowest rates of relapse. Standard six-month regimens are adequate for the treatment of GUTB. Directly observed treatment, short-course (DOTS is the internationally recommended comprehensive strategy to control TB, and directly observed treatment is just one of its five elements. DOTS cures not only the individual with TB but also reduces the incidence of TB as well as the prevalence of primary drug-resistance in the community. Corticosteroids have no proven role in the management of patients with GUTB. Errors in prescribing anti-TB drugs are common in clinical practice. Standardized treatment regimens at correct doses and assured completion of treatment have made DOTS the present-day standard of care for the management of all forms of TB including GUTB.

The international management standards allow their integrated approach, thereby combining aspects of particular importance to the activity of any organization, from the quality management systems or the environmental management of the information security systems or the business continuity management systems. Although there is no national or international regulation, nor a defined standard for the IntegratedManagement System, the need to implement an integrated system occurs within the organization, which feels the opportunity to integrate the management components into a cohesive system, in agreement with the purpose and mission publicly stated. The issues relating to information security in the organization, from the perspective of the management system, raise serious questions to any organization in the current context of electronic information, reason for which we consider not only appropriate but necessary to promote and implement an IntegratedManagement System Quality - Environment - Health and Operational Security - Information Security

This study uses discourse, ideology and hegemony as a theoretical foundation to investigate the development of the polarised discourses of management accounting and the medical profession during the introduction of a NPM reform in the public health care debate, using Denmark as a case study. 194...... newspaper articles and 73 medical profession articles from 2002 to 2008 are analysed, using critical discourse analysis. The analysis shows that the management accounting discourse becomes the dominating ideology which is embedded in the public rhetorical debate. There are three peculiar outcomes...... perspective of a patient oriented focus to a quantitative focus through strong rationalised arguments. This puts the medical profession in a dilemma concerning their ideological Hippocratic Oath versus the NPM efficiency focus. However, they choose to gradually adopt management accounting terms in their own...

Reductive logic has been a major reasoning style in development of modern biomedical sciences. However, when "medical humanities" is developed by reductive reasoning, integrative and holistic values of humanities tend to be weakened. In that sense, identity and significance of "medical humanities" continue to be controversial despite of its literal clarity. Humanities in medical education should be established by strengthening humanistic and socialistic aspects of regular medical curriculum as well as developing individual "medical humanities" programs.

Probabilistic Risk Assessment (PRA) is a modeling tool used to predict potential outcomes of a complex system based on a statistical understanding of many initiating events. Utilizing a Monte Carlo method, thousands of instances of the model are considered and outcomes are collected. PRA is considered static, utilizing probabilities alone to calculate outcomes. Dynamic Probabilistic Risk Assessment (dPRA) is an advanced concept where modeling predicts the outcomes of a complex system based not only on the probabilities of many initiating events, but also on a progression of dependencies brought about by progressing down a time line. Events are placed in a single time line, adding each event to a queue, as managed by a planner. Progression down the time line is guided by rules, as managed by a scheduler. The recently developed IntegratedMedical Model (IMM) summarizes astronaut health as governed by the probabilities of medical events and mitigation strategies. Managing the software architecture process provides a systematic means of creating, documenting, and communicating a software design early in the development process. The software architecture process begins with establishing requirements and the design is then derived from the requirements.

Several technologies have been developed to support people's medicationmanagement, including pillboxes, specialized software applications, reminders and paper-based medication lists. Several of these technologies were discovered in older adults' homes during user studies carried out with the main...... purpose to help them to manage their medications and recall challenges. We confirm that a considerable number of older adults integrate their medication treatments into their daily life routines, and that the lack of knowledge, caregiver's support, medicine outside the home, forgetting medication intake...... towards the design of a personalized medicationmanagement system. We further describe our initial stage in a participatory design process as part of the ongoing Lev Vel Consortium....

The aim of the work is studying the possibilities of ontological engineering in managing of medical knowledge. And also practical implementation of knowledge management system (KMS) in medical university. The educational process model is established that allows analyzing learning results within time scale. Glossary sub-system has been developed; ontologies of educational disciplines are constructed; environment for setup and solution of situational cases is established; ontological approach to assess competencies is developed. The possibilities of the system for solving situation tasks have been described. The approach to the evaluation of competence has been developed.

Full Text Available These days, treatment in dentistry is no longer for patient without complication, but also for patient with bad medical record. With correct treatment management in handling medical condition of patient, not only for dental treatment but also their systematic disease, all the dental staff also can improve for the better quality of life of the patient. Patient with medical compromised start to realize that keeping good oral hygiene is so important for their lives, therefore dental staff need to improve their science and technology and also for facing patient with medical compromised. This article will discuss and suggest various treatment consideration and protocol for the patient of with medical compromised.

Full Text Available Overactive bladder (OAB, as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat.

The NASA IntegratedMedical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

The preparer (also called the “planner”) plays a key role in the integrated work management (IWM) process at Los Alamos National Laboratory (LANL). This course, Integrated Work Management: Preparer (COURSE 31883), describes the IWM roles and responsibilities of the preparer. This course also discusses IWM requirements that must be met by the preparer.

Full Text Available Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci. established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessible and freely shared within and amongst the scientific community. Accordingly, J Mind Med Sci. is an online, open access, non-for-profit journal which, because of individual/ private support, has levied no charges for submission, review, and publication of articles. All published articles may be freely downloaded and used by anyone from anywhere for scientific purposes. Journal of Mind and Medical Sciences is published by ValpoScholar/ Valparaiso University using the leading institutional repository platform of Digital Commons (powered by Bepress and under the local management of Jon Bull, Library Services, Valparaiso University, which combines submission management, editorial, and peer-review tools into a unique and flexible publishing software system. These editorial and publishing norms have facilitated the journal’s evolution, now indexed and abstracted in several international respected databases. Journal visibility is wide among international academic institutions and readers, as documented by the number of downloaded articles cited in respected journals, some indexed by Thomson Reuters and having high impact factors. In addition, published authors in J Mind Med Sci. periodically receive a statistical report about views / downloads of their articles. It is a pleasure and honor to thank all those who have thus far supported the journal activity (authors, reviewers, editorial board and assistance, publishing support, and to further invite and encourage

Medical terminological knowledge bases play an increasingly important role in medicine. As their size and complexity are growing, the need arises for a means to verify and maintain the consistency and correctness of their contents. This is important for their management as well as for providing

Full Text Available The importance of organizational-stakeholder relationships is highlighted in most organizational studies literature. This article investigates the relationship between medical practices and their stakeholders and has been developed to provide guidance on stakeholder engagement and communication. It is intended to provide a useful reference point for all medical practices concerning stakeholder engagement activities. Direction is provided on how to identify and ultimately engage with stakeholders. It should hopefully further develop the effectiveness of engagement efforts that are undertaken between a medical practice and its stakeholders. The ability of a medical practice to cultivate and sustain strong relationships with its prominent stakeholder groups greatly enhances the likelihood that the relationship will endure. Medical practitioners in South Africa are generally in urgent need of pursuing new ways of delivering quality health care through developing new service models that have been developed with the help of relevant stakeholders. Since stakeholder relationship management is critical for corporate sustainability, medical practice management should seek strategic direction by investigating the relative competitive threat and relative supportive value of each stakeholder and then classify them accordingly.

Medical employes handling medical radiation are increasing in recent years. In connection with the radiation exposure management, it was surveyed how much their cumulative exposure doses are and how many employes distribute in respective exposure levels. The medical employes surveyed are physicians, radiation technicians and nurses, working in the hospitals of educational institutions. The period of survey is every three years, from 1962 to 1977. For X-ray and ν-ray, respectively, the yearly cumulative exposure doses were measured by film badges, stepwise starting from below 500 mrem upward to over 5000 mrem; for the respective groups of employes, the percentage in each dose level was shown. The percentage in the level below 500 mrem was the largest in all groups, and in both X-ray and ν-ray, the percentages in higher levels decreased sharply to less than 7%. The exposure management has been improved in recent years. (J.P.N.)

Medical employes handling medical radiation are increasing in recent years. In connection with the radiation exposure management, it was surveyed how much their cumulative exposure doses are and how many employes distribute in respective exposure levels. The medical employes surveyed are physicians, radiation technicians and nurses, working in the hospitals of educational institutions. The period of survey is every three years, from 1962 to 1977. For X-ray and ..gamma..-ray, respectively, the yearly cumulative exposure doses were measured by film badges, stepwise starting from below 500 mrem upward to over 5000 mrem; for the respective groups of employes, the percentage in each dose level was shown. The percentage in the level below 500 mrem was the largest in all groups, and in both X-ray and ..gamma..-ray, the percentages in higher levels decreased sharply to less than 7%. The exposure management has been improved in recent years.

Technology can be used to supplement healthcare provider diabetes care by providing both educational and motivational support. Education can be provided using technology allowing patients to learn new practices and routines related to diabetes management. Technology can support daily diabetes self-management activities including blood glucose monitoring, exercising, healthy eating, taking medication, monitoring for complications, and problem-solving. This article describes an integrative revi...

Goverment of Uganda; Department for International Development (DFID) of the UK Government

2007-01-01

Metadata only record In 1999, the Integrated Co-management of Lakes through Beach Management Units project was started in an effort to implement a new approach to the management of lake resources in Uganda. The main components of this plan involved decentralization, local community management, and improving the livelihood of the poor. In order to finance the management of these areas, the Beach Management Units (BMU's) are charging user fees to those individuals who obtain benefit from the...

Full Text Available The development, features and integrating abilities of different international standards related to management systems are discussed. A group of such standards that augment the performance of quality management systems in organizations is specifically focused on. The concept, characteristics and an illustrative example of one augmenting standard, namely ISO 10001, are addressed. Integration of standardized augmenting systems, both by themselves and within the overall management system, is examined. It is argued that, in research and practice alike, integrative augmentation represents the future of standardized quality and other management systems.

INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context,

To consider waste as a resource instead of an annoyance with which the management has to cope with, has become an unavoidable task for modern managers. The task the management has to take to secure competitiveness in an environment of rising complexity of production processes and further increasing legal requirements, is to manage waste as much as other recourses are managed. Waste has to be considered an aspect of planning and decision process just as business plans or logistics are. Main themes discussed in this publication comprise waste management, implementation of waste management as an integral part of environmental management systems, and management approach to waste - the results. 4 figs.

Integrated waterbird management over the past few decades has implicitly referred to methods for managing wetlands that usually attempt to enhance habitat for taxonomic groups such as shorebirds and wading birds, in addition to waterfowl, the traditional focus group. Here I describe five elements of integration in management: taxonomic, spatial, temporal, population and habitat, and multiple-use management objectives. Spatial integration simply expands the scale of management concern. Rather than emphasizing management on a very limited number of impoundments or wetlands in small refuges or wildlife management areas, the vision is beginning to shift to connectivity within larger landscapes on the order of many square kilometers as telemetry data on daily and seasonal movements for many species become available. Temporal integration refers to the potential for either simultaneous management for waterbirds and commercial 'crops' (e.g., crayfish and rice) or for temporally-staggered management such as row crop production in spring-summer growing seasons and waterbird management on fallow fields in the non-growing (winter) season. Integrating population dynamics with habitats has become a major research focus over the past decade. Identifying which wetlands are ?sources? or ?sinks? for specific populations provides managers with critical information about effective management. Further, the applications of spatially explicit population models place heavy demands on researchers to identify use patterns for breeding and dispersing individuals by age, sex, and reproductive class. Population viability analysis models require much the same information. Finally, multiple-use managementintegration refers to trying to optimize the uses of wetlands, when only one (perhaps secondary) use may include waterbird management. Depending upon the ownership and primary land use of a particular parcel of land containing wetlands and/or water bodies, managing for waterbirds may be an

This article studies systems integrators' export channel pricing management for integrated solutions. We find support from our empirical case study for the notion that a systems integrator's export channel pricing strategy is multidimensional and dependent on international pricing environment and partner characteristics and that export partnerships have unique implications on a systems integrator's pricing process. The results show that giving up pricing control in export channel context may ...

This report covers Germany`s experience with integrated solid waste management programs. The municipal solid waste practices of four cities include practices and procedures that waste facility managers with local or state governments may consider for managing their own day-to-day operations.

Ways in which the ranking of the Space Station Module Power Management and Distribution testbed may be achieved and an individual subsystem's internal priorities may be managed within the complete system are examined. The application of these results in the integration and performance leveling of the autonomously managed system is discussed.

The rising spate of malpractice cases against doctors appearing in the press and annual reports of medical insurance companies causes concern. Are our doctors more careless or is the public more conscious of litigation? A well publicized malpractice case can ruin the doctor's career and practice. It is well worth a doctor's while to know the pitfalls and learn how to prevent them, and if a mistake happens, how to manage it. Not all mistakes amount to negligence. How will the court view these cases? Some local cases are cited to illustrate the difference between misadventure and negligence. They will serve as guidelines for good medical practice.

The person-in-charge (PIC) plays a key role in the integrated work management (IWM) process at Los Alamos National Laboratory (LANL, or the Laboratory) because the PIC is assigned responsibility and authority by the responsible line manager (RLM) for the overall validation, coordination, release, execution, and closeout of a work activity in accordance with IWM. This course, Integrated Work Management: PIC (Course 31884), describes the PIC’s IWM roles and responsibilities. This course also discusses IWM requirements that the PIC must meet. For a general overview of the IWM process, see self-study Course 31881, Integrated Work Management: Overview. For instruction on the preparer’s role, see self-study Course 31883, Integrated Work Management: Preparer.

Database integrity constraints, understood as logical conditions that must hold for any database state, are not fully supported by current database technology. It is typically up to the database designer and application programmer to enforce integrity via triggers or tests at the application level....... 2.~In concurrent database systems, besides the traditional correctness criterion, the execution schedule must ensure that the different transactions can overlap in time without destroying the consistency requirements tested by other, concurrent transactions....

The management team of the future will enter an environment requiring facilitation, participation, clinical, and empowerment skills. Those individuals who possess a clinical orientation as well as business expertise will be sought to manage multidisciplinary units. The rapid changes in the health-care environment have forced organizations to restructure their operations. To achieve quality care, customer satisfaction, cost-effectiveness, and efficiency, service integration across the organization will be required. As we approach the 21st century, this standard will evolve until "all levels are managing patient care." Some of the restructuring trends occurring in the health-care industry have been collaboration service integration, management consolidation, and job elimination. The emphasis for the multidisciplinary manager of the future will include integrating the professional and clinical services, managing information, building community partnerships, promoting physician collaboration, and managing the change process. A model organization in the next century will move toward a people-oriented system with inclusion and empowerment initiatives. Service integration will affect all organizations, but the disciplines within the Clinical Support System will be the most affected. Future opportunities of leadership will exist for pathologists, nurses, or medical technologists as the professional silos of managers and clinicians continue to crumble.

Radiation Emergencies which result as a consequence of nuclear or radiological accidents can produce a spectrum of different types of radiation injuries which could include cases of whole body irradiation causing Acute Radiation Syndrome, partial body irradiation, radiation burns (localized irradiation), radioactive contamination and combined injuries having component of conventional injuries. General principles of managing these cases entail doing triage, offering immediate emergency care and instituting definitive treatment. Infra-structural facilities which are required to facilitate their management include first aid post at plant site, personnel decontamination centre, site clinic and specialized hospital which can offer comprehensive investigational and treatment modalities. Training of medical and paramedical personnel is crucial as part of emergency preparedness programme and if needed, help can be sought from WHO's Radiation Emergency Medical Preparedness and Assistance Network Centres. (author)

Full Text Available Abstract Obesity is a growing international health problem that has already reached epidemic proportions, particularly within the United States where a majority of the population is overweight or obese. Effective methods of treatment are needed, and should be taught to physicians by efficient means. There exists a disconnect between the rising obesity prevalence with its high toll on medical resources, and the lack of obesity education provided to practitioners in the course of their training. One particular shortfall is the lack of representation of obesity on standardized medical examinations. Physician attitudes toward obesity are influenced by their lack of familiarity with the management of the disease. This may include dietary restriction, increasing physical activity, behavior modification, pharmacotherapy, and surgical interventions. Thus, curricular changes in the medical education of obesity could help reduce morbidity and mortality associated with this disease.

Medicationmanagement is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medicationmanagement process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche

integration of data and information in policy and management, combining expertise from nature and social science, to reach a balanced and sustainable development of the coastal zone. This important book comprises the proceedings of The International Symposium on Integrated Coastal Zone Management, which took....../mitigation to change in coastal systems Coastal governance Linking science and management Comprising a huge wealth of information, this timely and well-edited volume is essential reading for all those involved in coastal zone management around the globe. All libraries in research establishments and universities where...

This document is intended as a listing and discussion of the Requirements for the I-15 Integrated Corridor Management System : (ICMS) Demonstration Project in San Diego. This document describes what the system is to do (the functional requirements), ...

Integrated Pest Management Collaborative Research Support Program) has been applying a farmer participatory IPM strategy at on-farm research sites in eastern Uganda since 1995. Following five years of project implementation an evaluation ...

The objective of this research is to demonstrate the potential benefits for agency-wide data integration for VDOT asset management. This objective is achieved through an example application that requires information distributed across multiple databa...

Vertical integration of medical education is currently a prominent international topic, resulting from recent strategic initiatives to improve medical education and service delivery in areas of poorly met medical need. In this article, vertical integration of medical education is defined as 'a grouping of curricular content and delivery mechanisms, traversing the traditional boundaries of undergraduate, postgraduate and continuing medical education, with the intent of enhancing the transfer of knowledge and skills between those involved in the learning-teaching process'. Educators closely involved with vertically integrated teaching in the Riverland of South Australia present an analytical description of the educational dynamics of this system. From this analysis, five elements are identified which underpin the process of successful vertical integration: (1) raised educational stakes; (2) local ownership; (3) broad university role; (4) longer attachments; and (5) shared workforce vision. Given the benefits to the Riverland medical education programs described in this paper, it is not surprising that vertical integration of medical education is a popular goal in many rural regions throughout the world. Although different contexts will result in different functional arrangements, it could be argued that the five principles outlined in this article can be applied in any region.

In the last years several internationally accepted standards such as the ISO 9000 and ISO 14000 series and other function-specific management systems standards have been developed. At the same time, it has become imperative for organisations to continuously improve their overall quality, environmental and safety performance. Therefore, the need to create integratedmanagement systems is of growing importance to enable an easier handling of the different management systems. This paper has two main objectives. The first one is to address the key issues in the underlying theory of integratedmanagement systems including benefits and limits, the second one is to illustrate the importance of an integrated (in particular safety) management system and the experience feedback providing examples from different areas and different organisations in the nuclear field. (orig.)

Solving water management problems involves technical, social, economic, political and legal challenges and thus requires an integrated approach involving people from different backgrounds and roles. The integrated approach has been given a prominent role within the European Union¿s Water Framework

Purpose: It is widely acknowledged that aspects of sustainable development (SD) should be integrated into higher level operations management (OM) education. The aim of the paper is to outline the experiences gained at Chalmers University of Technology in Sweden from integrating aspects of SD into OM courses. Design/methodology/approach: The paper…

Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, ...

of IT on process innovations, the association between business process management and IT management is under-explored. Drawing on a literature analysis of the capabilities of business process and IT governance frameworks and findings from a case study, we propose the need for horizontal integration between the two......The importance of business processes and the centrality of IT to contemporary organizations' performance calls for a specific focus on business process management and IT management. Despite the wide scope of business process management covering both business and IT domains, and the profound impact...... management functions to enable strategic and operational business - IT alignment. We further argue that the role of IT in an organization influences the direction of integration between the two functions and thus the choice of integration mechanisms. Using case study findings, we propose...

for strategic management of collaborative relationships on a line with the purchasing perspectives offered by Supply Chain Management. Based on a study of the literature and an in-depth case study carried out within a large Scandinavian contractor, this article gives a proposal for how Partnering can...... be supported by strategic purchasing, with the aim of achieving strategic Partnering. The contribution of this article is thus the development of a new purchasing perspective within Construction Supply Chain Management.......Developments in the construction industry, with a lack of productivity increases compared to manufacturing industry in general, have amongst other things led to the use of Partnering, which is a form of collaboration which attempts to counteract the distrust and the sub-optimisation which...

This is an interventional study, since a training has been given, performed in order to investigate whether training has significant impact on knowledge levels of healthcare managers (head-nurses, assistant head nurses, hospital managers and deputy managers) regarding bio-medical waste management. The study was conducted on 240 volunteers during June - August 2010 in 12 hospitals serving in Istanbul (private, public, university, training-research hospitals and other healthcare institutions). A survey form prepared by the project guidance team was applied to the participants through the internet before and after the training courses. The training program was composed of 40 hours of theory and 16 hours of practice sessions taught by persons known to have expertise in their fields. Methods used in the analysis of the data chi-square and t-tests in dependent groups. 67.5% (162) of participants were female. 42.5% (102) are working in private, and 21.7% in state-owned hospitals. 50.4% are head-nurses, and 18.3% are hospital managers.A statistically significant difference was found among those who had received medical waste management training (preliminary test and final test) and others who had not (pnecessity for the safety of patients and important for its contribution to the economy of the country.

In 2007, several important initiatives in the North American waterfowl management community called for an integrated approach to habitat and harvest management. The essence of the call for integration is that harvest and habitat management affect the same resources, yet exist as separate endeavours with very different regulatory contexts. A common modelling framework could help these management streams to better understand their mutual effects. Particularly, how does successful habitat management increase harvest potential? Also, how do regional habitat programmes and large-scale harvest strategies affect continental population sizes (a metric used to express habitat goals)? In the ensuing five years, several projects took on different aspects of these challenges. While all of these projects are still on-going, and are not yet sufficiently developed to produce guidance for management decisions, they have been influential in expanding the dialogue and producing some important emerging lessons. The first lesson has been that one of the more difficult aspects of integration is not the integration across decision contexts, but the integration across spatial and temporal scales. Habitat management occurs at local and regional scales. Harvest management decisions are made at a continental scale. How do these actions, taken at different scales, combine to influence waterfowl population dynamics at all scales? The second lesson has been that consideration of the interface of habitat and harvest management can generate important insights into the objectives underlying the decision context. Often the objectives are very complex and trade-off against one another. The third lesson follows from the second – if an understanding of the fundamental objectives is paramount, there is no escaping the need for a better understanding of human dimensions, specifically the desires of hunters and nonhunters and the role they play in conservation. In the end, the compelling question is

Full Text Available Background:This is an interventional study, since a training has been given, performed in order to investigate whether training has significant impact on knowledge levels of healthcare managers (head-nurses, assistant head nurses, hospital managers and deputy managers regarding bio-medical waste management.Methods:The study was conducted on 240 volunteers during June – August 2010 in 12 hospitals serving in Istanbul (private, public, university, training-research hospitals and other healthcare institutions. A survey form prepared by the project guidance team was applied to the participants through the internet before and after the training courses. The training program was composed of 40 hours of theory and 16 hours of practice sessions taught by persons known to have expertise in their fields. Methods used in the analysis of the data chi-square and t-tests in dependent groups.Results:67.5% (162 of participants were female. 42.5% (102 are working in private, and 21.7% in state-owned hospitals. 50.4% are head-nurses, and 18.3% are hospital managers.A statistically significant difference was found among those who had received medical waste management training (preliminary test and final test and others who had not (p<0.01. It was observed that information levels of all healthcare managers who had received training on waste management had risen at the completion of that training session.Conclusion:On the subject of waste management, to have trained healthcare employees who are responsible for the safe disposal of wastes in hospitals is both a necessity for the safety of patients and important for its contribution to the economy of the country.

Full Text Available The integration of health and safety, environmental and quality (HSEQ management systems has become a current topic in the 21st century, as the need for systems thinking has grown along with the number of management system standards. This study aims to map current developments and trends in integrated HSEQ management. Three viewpoints are taken: the current state of the main HSEQ management standards, research literature on integratedmanagement systems (IMS, and a case study of an industry-led HSEQ cluster in Northern Finland. The results demonstrate that some of the most prominent current trends are the harmonization of the high level structure of management systems by ISO, the evaluation of IMS, accounting for the supply chain in HSEQ issues, and sustainability and risk management. The results of the study can be used by practitioners to get a view of the current state of HSEQ management systems and their integration, and by researchers to seek out potential directions for HSEQ and IMS related research.

Integrated pest management, better known as IPM, is a familiar term for those of us working in forest, conservation, and native plant nurseries. An almost synonymous concept is "holistic pest management" that has been the topic of chapters in recent Agriculture Handbooks that would be useful to growers of native plants (see Landis and others 2009; Landis and...

The subject of this thesis is the integration of Operational Research and Environmental Management. Both sciences play an important role in the research of environmental issues. Part I describes a framework for the interactions between Operational Research and Environmental Management.

IT environments consist of both Windows and other platforms. Providing user account management for this model has become increasingly diffi cult. If Microsoft#s Active Directory could be enhanced to extend a W indows identity for authentication services for Unix, Linux, Java and Macintosh systems, then an integrated approach to user account manag ement could be realized.

Based on the practice of workflow, information management system about medical equipment was developed and its functions such as gathering, browsing, inquiring and counting were introduced. With dynamic and complete case management of medical equipment, the system improved the management of medical equipment.

The term 'vertical integration' is used broadly in medical education, sometimes when discussing community based medical education (CBME). This article examines the relevance of the term 'vertical integration' and provides an alternative perspective on the complexities of facilitating the CBME process. The principles of learner centredness, patient centredness and flexibility are fundamental to learning in the diverse contexts of 'community'. Vertical integration as a structural concept is helpful for academic organisations but has less application to education in the community setting; a different approach illuminates the strengths and challenges of CBME that need consideration by these organisations.

In the October 1993 issue of Physician Assistant, we published "Robots for Health Care," the first of two articles on the medical applications of robotics. That article discussed ways in which robots could help patients with manipulative disabilities to perform activities of daily living and hold paid employment; transfer patients from bed to chair and back again; add precision to the most exacting surgical procedures; and someday carry out diagnostic and therapeutic techniques from within the human body. This month, we are pleased to offer an article by Sharon Enright, an authority on pharmacy operations, who considers how an automated medication-management system that makes use of bar-code technology is capable of streamlining drug dispensing, controlling safety, increasing cost-effectiveness, and ensuring accurate and complete record-keeping.

Full Text Available This paper examines the role of the World Wildlife Fund for Nature China as policy entrepreneur in China. It illustrates the ways in which the World Wildlife Fund for Nature is active in promoting integrated river basin management in the Yangtze River basin and how the efforts at basin level are matched with the advice of the China Council for International Cooperation on Environment and Development task force on integrated river basin management to the national government of China. This article demonstrates that the World Wildlife Fund for Nature uses various strategies of different types to support a transition process towards integrated river basin management. Successful deployment of these strategies for change in environmental policy requires special skills, actions, and attitudes on the part of the policy entrepreneur, especially in China, where the government has a dominant role regarding water management and the position of policy entrepeneurs is delicate.

Full Text Available The planning of coastal spatial arrangement must be put in the valid spatial planning system. Law Number 26 of 2007 on Spatial Planning and it is in fact related with land spatial planning, although that ocean and air spatial management will be arranged in separate law. The legal for coastal zone management is determined by using the principles of integrated coastal management by focusing on area or zone authority system. The integrated of coastal zones management regulations should be followed by the planning of coastal spatial arrange­ment. Therefore, certain synchronization at coastal zones governance is very important issue since by integrating and coordinating other related regulations and therefore conflict of norm can be minimized in the spatial planning coastal zone.

The Dallas Integrated Corridor Management System Demonstration Project is a multi-agency, de-centralized operation which will utilize a set of regional systems to integrate the operations of the corridor. The purpose of the Dallas ICM System is to im...

Watershed information systems that integrate data and analytical tools are critical enabling technologies to support Integrated Water Resource Management (IWRM) by converting data into information, and information into knowledge. Many factors bring people to the table to participate in an IWRM fra...

The IntegratedMedical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Full Text Available The article gives a brief overview of the latest research in the direction of the use of the project-based approach to the management of medical institutions. It is shown that medicine today is a project-oriented area, and modern scientific studies suggest the use of not only the project management approach and portfolio management. The various scientific sources proposed the classification of projects of medical institutions, mechanisms of formation of projects portfolios of such institutions. The concept of integratedmanagement of medical institutions, which includes strategic, project, portfolio, program management approach (S3P-concept, is offered. According to this concept, the process of S3P-management of the medical institution will include four stages, which are closely interrelated. For the first time, the pair principles of S3P-management are formulated. The proposed concept and principles of S3P-management of medical institution require further development and creating of models, methods and integratedmanagement tools, as well as the development of a system of indicators verify compliance with the organization's strategy of its projects, projects portfolios and programs. This concept and the proposed integratedmanagement principles are universal and can be applied to any project-oriented area.

The paper discusses concepts and developments within water quantity, water quality, integrated environmental assessment and wastewater treatment. The historical and the global perspectives are used in the discussion of the role of engineers in today's society. Sustainabilty and ethics are taken...... into the analysis. There is a need for re-evaluation of the resource, society and environment scenarios with a view to the totality of the system and with proper analysis of the flow of water and matter through society. Among the tools are input-output analysis and cradle to grave analysis, in combination...... with compilation of identified sets of values with respect to sustainable use of resources and ultimate fate of the environment and quality of life. The role of the engineer is to make available to society as many technical options as possible - and to put these options into the proper perspective in relation...

The Integrated Materials Management System, when fully implemented, will provide the Y-12 National Security Complex with advanced inventory information and analysis capabilities and enable effective assessment, forecasting and management of nuclear materials, critical non-nuclear materials, and certified supplies. These capabilities will facilitate future Y-12 stockpile management work, enhance interfaces to existing National Nuclear Security Administration (NNSA) corporate-level information systems, and enable interfaces to planned NNSA systems. In the current national nuclear defense environment where, for example, weapons testing is not permitted, material managers need better, faster, more complete information about material properties and characteristics. They now must manage non-special nuclear material at the same high-level they have managed SNM, and information capabilities about both must be improved. The full automation and integration of business activities related to nuclear and non-nuclear materials that will be put into effect by the Integrated Materials Management System (IMMS) will significantly improve and streamline the process of providing vital information to Y-12 and NNSA managers. This overview looks at the kinds of information improvements targeted by the IMMS project, related issues, the proposed information architecture, and the progress to date in implementing the system.

Full Text Available Rapid urbanization and industrialization, population growth and economic growth in developing countries make management of municipal solid waste more complex comparing with developed countries. Furthermore, the conventional municipal solid waste management approach often is reductionists, not tailored to handle complexity. Therefore, the need to a comprehensive and multi-disciplinary approach regarding the municipal solid waste management problems is increasing. The concept of integrated solid waste management is accepted for this aim all over the world. This paper analyzes the current situation as well as opportunities and challenges regarding municipal solid waste management in Isfahan according to the integrated solid waste management framework in six aspects: environmental, political/legal, institutional, socio-cultural, financial/economic, technical and performance aspects. Based on the results obtained in this analysis, the main suggestions for future integrated solid waste management of Isfahan are as i promoting financial sustainability by taking the solid waste fee and reducing the expenses through the promoting source collection of recyclable materials, ii improving compost quality and also marketing the compost products simultaneously, iii promoting the private sector involvements throughout the municipal solid waste management system.

In the last 10 yr, the size and frequency of incidents affecting the communities and environment surrounding chemical processing facilities has increased. The chemical process industry, which has always concerned itself with the safety of its facilities, has responded by committing to stricter standards of operation and management. A critical element of these management practices is the use of a structured incident investigation program. Many facilities have implemented and disciplined themselves to perform good investigation of incidents. However, most of these facilities maintain incident investigation as part of their safety management programs. This allows the process to be disconnected from the management system that deals with the day-to-day business of the facility. The first step of integration is understanding the objectives and functions of the management system into which the integration is to occur. To begin, a common definition of management is needed. Management, for the purposes of this discussion, is defined as the system of activities used to control, coordinate, and improve the flow of work within a facility or organization. This definition refers to several concepts that need further development in order to understand how incident investigation can be integrated into a management system, including (a) flow of work, (b) control, and (c) improvement. Application can be made to the nuclear industry

The Integrated Materials Management System, when fully implemented, will provide the Y-12 National Security Complex with advanced inventory information and analysis capabilities and enable effective assessment, forecasting and management of nuclear materials, critical non-nuclear materials, and certified supplies. These capabilities will facilitate future Y-12 stockpile management work, enhance interfaces to existing National Nuclear Security Administration (NNSA) corporate-level information systems, and enable interfaces to planned NNSA systems. In the current national nuclear defense environment where, for example, weapons testing is not permitted, material managers need better, faster, more complete information about material properties and characteristics. They now must manage non-special nuclear material at the same high-level they have managed SNM, and information capabilities about both must be improved. The full automation and integration of business activities related to nuclear and non-nuclear materials that will be put into effect by the Integrated Materials Management System (IMMS) will significantly improve and streamline the process of providing vital information to Y-12 and NNSA managers. This overview looks at the kinds of information improvements targeted by the IMMS project, related issues, the proposed information architecture, and the progress to date in implementing the system

Rice growing is developed in different kinds of soils, and some of the have high bases saturation, especially calcium and magnesium, as well as medium to high carbonate contents. This causes negative effects in the development and growth of the rice plant. As a consequence, several researching actions have been under-taken, and they are aimed at becoming this problem in economically manageable. Among the strategies we have, some of them are as follows: evaluating rice varieties presenting tolerance to these soils; using inorganic fertilizers looking for a response to elements, sources, dose and application times; evaluating organic fertilizers, mainly the green ones; using amendments, and physical soil management. According to the results, we have the fertilization response with major and minor elements and with the statistical differences at a 0.05% level. A response was found with elements such as zinc, copper, boron, iron, phosphorus and potassium. However, the efficiency of these elements depends on the addition of amendments as sulfur, the use of green fertilizers and farming systems that eliminate the superficial compaction of these soils, besides the use of varieties which are more tolerant to alkalinity, just like Fedearroz-50

Full Text Available Background: The research work on entrepreneurship, enterprise's policy and management, which started in 1992, successfully continued in the following years. Between 1992 and 2011, more than 400 academics and other researchers have participated in research work (MER research program whose main orientation has been the creation of their own model of integralmanagement. Results: In past years, academics (researchers and authors of published papers from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Byelorussia, Canada, the Czech Republic, Croatia, Estonia, France, Germany, Hungary, Italy, Poland, Romania, Russia, the Slovak Republic, Slovenia, Switzerland, Ukraine, and the US have cooperated in MER programs, coming from more than fifty institutions. Thus, scientific doctrines of different universities influenced the development of the MER model which is based on both horizontal and vertical integration of the enterprises' governance and management processes, instruments and institutions into a consistently operating unit. Conclusions: The presented MER model is based on the multi-layer integration of governance and management with an enterprise and its environment, considering the fundamental desires for the enterprises' existence and, thus, their quantitative as well as qualitative changes. The process, instrumental, and institutional integrity of the governance and management is also the initial condition for the implementation of all other integration factors.

Purpose Although medical leadership and management (MLM) is increasingly being recognised as important to improving healthcare outcomes, little is understood about current training of medical students in MLM skills and behaviours in the UK. The paper aims to discuss these issues. Design/methodology/approach This qualitative study used validated structured interviews with expert faculty members from medical schools across the UK to ascertain MLM framework integration, teaching methods employed, evaluation methods and barriers to improvement. Findings Data were collected from 25 of the 33 UK medical schools (76 per cent response rate), with 23/25 reporting that MLM content is included in their curriculum. More medical schools assessed MLM competencies on admission than at any other time of the curriculum. Only 12 schools had evaluated MLM teaching at the time of data collection. The majority of medical schools reported barriers, including overfilled curricula and reluctance of staff to teach. Whilst 88 per cent of schools planned to increase MLM content over the next two years, there was a lack of consensus on proposed teaching content and methods. Research limitations/implications There is widespread inclusion of MLM in UK medical schools' curricula, despite the existence of barriers. This study identified substantial heterogeneity in MLM teaching and assessment methods which does not meet students' desired modes of delivery. Examples of national undergraduate MLM teaching exist worldwide, and lessons can be taken from these. Originality/value This is the first national evaluation of MLM in undergraduate medical school curricula in the UK, highlighting continuing challenges with executing MLM content despite numerous frameworks and international examples of successful execution.

This book begins with the premise that energy demands are directing scientists towards ever-greener methods of power management, so highly integrated power control ICs (integrated chip/circuit) are increasingly in demand for further reducing power consumption. * A timely and comprehensive reference guide for IC designers dealing with the increasingly widespread demand for integrated low power management * Includes new topics such as LED lighting, fast transient response, DVS-tracking and design with advanced technology nodes * Leading author (Chen) is an active and renowned contributor to the power management IC design field, and has extensive industry experience * Accompanying website includes presentation files with book illustrations, lecture notes, simulation circuits, solution manuals, instructors manuals, and program downloads.

Three periods of the development of military medical service management in Ukraine can be outlined according to the findings of the conducted study, they are the following: formation (1992-1994), consolidation and development (the end of 1994-2003), functional and structural transformation (2004). Leading tendencies of the formation of the management of medical military service in the period are shown in the article to be democratization and structural order of units of the system of the management of military service, integration of efforts and resources of medical military service in one medically covered area of the state, introduction and intensive expansion in army prophylactic and treatment institutions of wide spectrum of requiring payment medical service, rendering out-patient medical service to armed forces personnel and pensioner of Ministry of Defense by family physicians, orientation toward effective management.

An integrated approach to plant life management has been developed for CANDU reactors. Strategies, methods, and procedures have been developed for assessment of critical systems structures and components and for implementing a reliability centred maintenance program. A Technology Watch program is being implemented to eliminate 'surprises'. Specific work has been identified for 1998. AECL is working on the integrated program with CANDU owners and seeks participation from other CANDU owners

Medical educators need to be able to define excellence within the various roles they occupy so that they can demonstrate internationally recognized, high-quality scholarship. Previous definitions of scholarship have focused on research and teaching but have been unable to integrate other roles such as leadership, management, and administration. Clearer definition of the various roles of the medical educator, coupled with a broader understanding of medical education scholarship that is able to encompass management, as well as teaching and research, will help institutions to evaluate and reward faculty members appropriately. We propose that management should now be introduced as a third "priority of the professoriate." We outline the concept of the scholarly manager, particularly as it applies to management in medical education. We offer a new conceptual model which situates the role of the academic manager within the scholarship of medical education and shows it to be an essential part of the skills and competences of the excellent medical educator. We emphasize that at the heart of all scholarly activity in medical education lie the core skills, values, and behaviors shared by all involved in the education of doctors and medical students. Future research is needed to explore and, where possible, achieve consensus on the core skills, values, and behaviors of an excellent medical educator. In addition, work should commence to define and categorize the various stages in the development of a significant management portfolio in medical education teaching and research.

Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

Full Text Available The growing proliferation of management systems standards (MSSs, and their individualized implementation, is a real problem faced by organizations. On the other hand, MSSs are aimed at improving efficiency and effectiveness of organizational responses in order to satisfy the requirements, needs and expectations of the stakeholders. Each organization has its own identity and this is an issue that cannot be neglected; hence, two possible approaches can be attended. First, continue with the implementation of individualized management systems (MSs; or, integrate the several MSSs versus related MSs into an integratedmanagement system (IMS. Therefore, in this context, organizations are faced with a dilemma, as a result of the increasing proliferation and diversity of MSSs. This paper takes into account the knowledge gained through a case study conducted in the context of a Portuguese company and unveils some of the advantages and disadvantages of integration. A methodology is also proposed and presented to support organizations in developing and structuring the integration process of their individualized MSs, and consequently minimize problems that are generators of inefficiencies, value destruction and loss of competitiveness. The obtained results provide relevant information that can support Top Management decision in solving that dilemma and consequently promote a successful integration, including a better control of business risks associated to MSSs requirements and enhancing sustainable performance, considering the context in which organizations operate.

Risk Engineering Ltd is a private Bulgarian company in the field of scientific technical consultancy and engineering services, established in 1990. The aim of this report is to present the experience of Risk Engineering Ltd. in the development, implementation and operation of an integratedmanagement system. The process of implementation of the system was completed at the end of 2011. In January 2012, the Risk Engineering IntegratedManagement System was certified by Lloyd's Register for compliance with standards ISO 9001:2008, ISO 140001:2004 and BS OHSAS 18001:2007

Now that five years have passed (1999-2003) since the Owner Companies decided to merge the Asco and Vandellos-II nuclear power plants, we believe that, for IntegratedManagement through a single AIE, it is timely and advisable to describe the key issues of the process implemented to optimize economic results, always in accordance with the Policies of Nuclear Safety, Quality and Environment, Prevention, Human Factors and Availability, and we emphasize the following as essential elements: The Corporate Model; strategic/Operating Plans; integrated Economic Management Model SIE; Rationalization of the organizational structure, Continuous Training; Analysis of Processes and Procedures. (Author)

Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessibl...

Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.

Most corporate risk management research focuses on particular risk exposures to the exclusion of other interrelated exposures. By contrast, this study models corporate risk exposures using a multivariate approach integrating the distinct exposures of interest to finance and strategy researchers. The paper addresses the implications of multivariate modeling for corporate risk management, some key methodological issues arising in empirical estimation of corporate economic exposrues, and direc...

Organizations are becoming more aware of the importance of integratedmanagement systems (IMS). Interest in this subject indicates that IMS are seen as "management systems of the future". Based on this, the aim of this articles characterizes the possibility of building IMS through the identification of common elements and specific requirements in accordance with the ISO 9001, ISO 14001 and OHSAS 18001 professional references. Part of the article is the methodology of building IMS in the organization.

Implementation of waste management technologies has been hindered by the intervention of diverse interests. Relying on a perceived history of inadequate and improper management, operations, and technological design, critics have stymied the implementation of scientifically and governmentally approved technologies and facilities, leading to a critical shortage of hazardous, mixed, and radioactive waste management capacity. The research and development (R ampersand D) required to identify technologies that are simultaneously (1) scientifically valid, (2) economically sound, and (3) publicly acceptable must necessarily address, in an integrated and interdisciplinary manner, these three criteria and how best to achieve the integration of stakeholders early in the technology implementation process (i.e., R ampersand D, demonstration, and commercialization). The goal of this paper is to initiate an identification of factors likely to render radioactive and hazardous waste management technologies publicly acceptable and to provide guidance on how technological R ampersand D might be revised to enhance the acceptability of alternative waste management technologies. Principal among these factors are the equitable distribution of costs, risks, and benefits of waste management policies and technologies, the equitable distribution of authority for making waste management policy and selecting technologies for implementation, and the equitable distribution of responsibility for resolving waste management problems. Stakeholder participation in assessing the likely distribution of these factors and mitigative mechanisms to enhance their equitable distribution, together with stakeholder participation in policy and technology R ampersand D, as informed by stakeholder assessments, should enhance the identification of acceptable policies and technologies

Development of B C Gas Utility Limited's integrated work and cost management system was described, with emphasis on cost management without reliance on the financial systems, and standard costing and operational side benefits. The objectives of the system were identified as dynamic monitoring and control, and local empowerment. The concept underlying the two systems was explained in detail. In the case of the work management system the ability to manage all work in operations areas was stressed, along with its universal availability. Other benefits expected included improved resource utilization, improved productivity, better control of cost, improved revenue generation, superior customer service, a simplified financial system, and improved employee motivation through empowerment

Medical simulation has recently been used in medical education, and evidence indicates that it is a valuable tool for teaching and evaluation. Very few studies have evaluated the integration of medical simulation in medical physiology education, particularly in PA programs. This study was designed to assess the value of integratingmedical simulation into the PA physiology curriculum. Seventy-five students from the PA program at Central Michigan University participated in this study. Mannequin-based simulation was used to simulate a patient with hemorrhagic shock and congestive heart failure to demonstrate the Frank-Starling force and cardiac function curve. Before and after the medical simulation, students completed a questionnaire as a self-assessment. A knowledge test was also delivered after the simulation. Our study demonstrated a significant improvement in student confidence in understanding congestive heart failure, hemorrhagic shock, and the Frank-Starling curve after the simulation. Medical simulation may be an effective way to enhance basic science learning experiences for students and an ideal supplement to traditional, lecture-based teaching in PA education.

Risk management in Medical Biology Laboratory (MBL) which includes hygiene and waste management, is an integrated process to the whole MBL organisation. It is composed of three stages: risks factors identification, grading and prioritization, and their evaluation in the system. From the legislation and NF EN ISO 15189 standard's requirements viewpoint, prevention and protection actions to implement are described, at premises level, but also at work station environment's one (human resources and equipments) towards biological, chemical, linked to gas, to ionizing or non ionizing radiations and fire riks, in order not to compromise patients safety, employees safety, and quality results. Then, although NF EN 15189 standard only enacts requirements in terms of prevention, curative actions after established blood or chemical exposure accident are defined.

A joint project cluster of industry, VTT and other R and D suppliers is dealing with managing of lifetime of critical structures and components in energy and process industry. The research topics include systematic component lifetime management, data management, integrity and lifetime of pressure bearing components, non-destructive inspection, interactions of coolant and materials, environmentally assisted cracking and ageing of reactor internals. This Symposium is a compilation of selected papers describing an intermediate status of the projects after three years of research and development. (orig.)

Thirty-seven papers are presented that summarize the findings from research and development work conducted as a part of the Integrated Pest Management RD&A Program for Bark Beetles of Southern Pines during the 5-year period 1980-85. Presentations cover the areas of sampling and impact assessment, bark beetle biology and ecology, host susceptibility, host/pest...

The state of Illinois is encouraging schools to better inspect and evaluate the causes of their pest infestation problems through use of the Integrated Pest Management (IPM) guidelines developed by the Illinois Department of Public Health. This guide reviews the philosophy and organization of an IPM program for structural pests in schools,…

This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

This paper examines the role of the World Wildlife Fund for Nature China as policy entrepreneur in China. It illustrates the ways in which the World Wildlife Fund for Nature is active in promoting integrated river basin management in the Yangtze River basin and how the efforts at basin level are

Background: Save the Children Tanzania has been supporting several projects in Lindi Region including implementation of health facility based IntegratedManagement of Childhood Illness (IMCI) services in Kilwa, Ruangwa and Lindi rural districts. The objective of this study was to assess the IMCI services in a sample of ...

Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations. To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine. We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally. Development of a coherent set of learning objectives will

Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

The Integrated Environment, Safety, and Health Management System Description that is presented in this document describes the approach and management systems used to address integrated safety management within the Richland Environmental Restoration Project

The present paper is predominantly a conceptual contribution with an appraisal of major developments in risk informed structural integritymanagement for offshore installations together with a discussion of their merits and the challenges which still lie ahead. Starting point is taken in a selected...... overview of research and development contributions which have formed the basis for Risk Based Inspection Planning (RBI) as we know it today. Thereafter an outline of the methodical basis for risk informed structural systems integritymanagement, i.e. the Bayesian decision analysis is provided in summary....... The main focus is here directed on RBI for offshore facilities subject to fatigue damages. New ideas and methodical frameworks in the area of robustness and resilience modeling of structural systems are then introduced, and it is outlined how these may adequately be utilized to enhance Structural Integrity...

The recently issued International Atomic Energy Agency (IAEA) publications (GS-R-3, GS-G-3.1 and GS-G-3.5) regarding Management Systems for Facilities and Activities define requirements for creation, introduction, evaluation and continuously improvement of the Management System, which unifies the safety, health, environment, security, quality and economic elements. According to GS-R-3 the IntegratedManagement System is based on defined processes identified in the enterprises: Managing, Basic and Supporting processes. At implementation of their activities, the organizations often apply other standards in their interrelations with suppliers and the parties concerned - ISO 9001:2008, ISO 14001:2004 and OHSAS 18001:2007, regarding quality, environment and occupational health and safety management. The integration of the standards of both series ensure the observance of the common management principles that reflect the best practices of management as leadership, participation of the people, process approach, continuously improvement, systematical approach to the management and approach based on facts used at the making decisions. The main objective of the IntegratedManagement System introduction is to ensure safety considering the influence of all additional impacts taken together. The IntegratedManagement System is based on the process approach at implementation of the activities in nuclear power plant. The transition to the process oriented approach require long period of time, during which the distribution of the responsibilities is optimized up to the level that will satisfy the requirements, reach and maintain the stipulated objectives. The Configuration Management (CM) is an integratedmanagement process by means of which conformity between design requirements, physical configuration and the plant documentation is ascertained and maintained during the entire life cycle of the facility. Processes within configuration management are not isolated, but are part of

Abstract Background: Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE. Methods and analyses: The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool. Dissemination: This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. Trial registration number: PROSPERO 2018 CRD42018085205 PMID:29595669

The medical back belt with integrated neuromuscular electrical stimulation is anorthopedic device, which has two main functions. The first function is to stimulate the backmuscles by using a neuromuscular electrical stimulation device that releases regular,electrical impulses. The second function of

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. Related to how the medical home is integrated into the EHDI process, 273 items were listed by 48 coordinators, and themes were identified…

This paper discusses the methods and systems for optimizing the following supplements 10 and 17 for national health and medical care. The supplements 10 and 17 of DICOM (digital imaging and communications in medicine) system, which is now under progress for the purpose to keep compatibility within medical image information system as an international standard, are important for making the cooperation between HIS (hospital information system)/RIS (radiation information system) and modality (imaging instruments). Supplement 10 concerns the system to send the information of patients and their orders through HIS/RIS to modality and 17, the information of modality performed procedure step (MPPS) to HIS/RIS. The latter defines to document patients' exposure, a part of which has not been recognized in Japan. Thus the medical information system can be useful for risk-management of medical exposure in future. (K.H.)

This paper discusses the methods and systems for optimizing the following supplements 10 and 17 for national health and medical care. The supplements 10 and 17 of DICOM (digital imaging and communications in medicine) system, which is now under progress for the purpose to keep compatibility within medical image information system as an international standard, are important for making the cooperation between HIS (hospital information system)/RIS (radiation information system) and modality (imaging instruments). Supplement 10 concerns the system to send the information of patients and their orders through HIS/RIS to modality and 17, the information of modality performed procedure step (MPPS) to HIS/RIS. The latter defines to document patients' exposure, a part of which has not been recognized in Japan. Thus the medical information system can be useful for risk-management of medical exposure in future. (K.H.)

Radioactive waste management is to be included in the IntegratedManagement System (IMS) which pursues the continuous improvement of the company's quality, occupational safety and health, and environment protection processes. Radioactive waste management is based on the following aspects: optimization of human and material resources for execution of tasks, including the provision of a radiation protection supervisor to watch over the management of radioactive waste; improved documentation (management plan and procedures); optimization of operational levels for waste classification and release; maintenance of generation records and history through a database that facilitates traceability of information; implementation of radioactive waste segregation at source (source identification, monitoring and decontamination) activities intended to reduce the amount of radioactive waste; licensing of initial storage site for radioactive waste control and storage; employee awareness training on radioactive waste generation; identification and evaluation of emergency situations and response planning; implementation of preventive maintenance program for safety related items; development and application of new, advanced treatment methodologies or systems. These aspects are inherent in the concepts underlying quality management (establishment of administrative controls and performance indicators), environment protection (establishment of operational levels and controls for release), occupational health and safety (establishment of operational controls for exposure in emergency and routine situations and compliance with strict legal requirements and standards). It is noted that optimizing the addressed aspects of a radioactive waste management system further enhances the efficiency of the IntegratedManagement System for Quality, Environment, and Occupational Safety and Health. (author)

Objective. To design, integrate, and assess the effectiveness of a medical humanities teaching module that focuses on pharmaceutical care for dementia patients.Design. Visual and textual dementia narratives were presented using a combination of teacher and learner-centered approaches with the aim being to highlight patients' and caregivers' needs for empathy and counselling.Assessment. As gauged from pre- and post-experience questionnaires, students highly rated this approach to teaching medical humanities. In-class presentations demonstrated students' increased sensitivity to patient and caregiver needs, while objective learning outcomes demonstrated students' increased knowledge and awareness.Conclusions. Pharmacy students were open to and successfully learned from reading and discussing patient and caregiver narratives, which furthers the discussion on the value of integrating the medical humanities into the curricula of pharmacy and other health sciences.

This book presents cutting-edge applications of, and up-to-date research on, ontology engineering techniques in the physical asset integrity domain. Though a survey of state-of-the-art theory and methods on ontology engineering, the authors emphasize essential topics including data integration modeling, knowledge representation, and semantic interpretation. The book also reflects novel topics dealing with the advanced problems of physical asset integrity applications such as heterogeneity, data inconsistency, and interoperability existing in design and utilization. With a distinctive focus on applications relevant in heavy industry, Ontology Modeling in Physical Asset IntegrityManagement is ideal for practicing industrial and mechanical engineers working in the field, as well as researchers and graduate concerned with ontology engineering in physical systems life cycles. This book also: Introduces practicing engineers, research scientists, and graduate students to ontology engineering as a modeling techniqu...

The Exploration Medical Capability (ExMC) element of the NASA Human Research Program (HRP) is charged with addressing the risk of unacceptable health and mission outcomes due to limitations of inflight medical capabilities. The Exploration Medical System Demonstration (EMSD) is a project within the ExMC element aimed at reducing this risk by improving the medical capabilities available for exploration missions. The EMSD project will demonstrate, on the ground and on ISS, the integration of several components felt to be essential to the delivery of medical care during long ]duration missions outside of low Earth orbit. The components of the EMSD include the electronic medical record, assisted medical procedure software, medical consumables tracking technology and RFID ] tagged consumables, video conferencing capability, ultrasound device and probes (ground demonstration only), peripheral biosensors, and the software to allow communication among the various components (middleware). This presentation seeks to inform our international partners of the goals and objectives of the EMSD and to foster collaboration opportunities related to this and future projects.

Full Text Available Objective In recent years, there has been a gradual but definitive shift in medical schools all over the globe to promote a more integrated way of teaching. Integration of medical disciplines promotes a holistic understanding of the medical curriculum in the students. This helps them better understand and appreciate the importance and role of each medical subject. Method The study was conducted among the 5th year Pre-clinical students. Questionnaire consisted of 4 questions on the level of integration, 5 questions on various aspects of the assessment and some questions which tested the level of awareness of the integrated method. Result Out of a total of 72 students present on the day of data collection, 65 participated in the study giving a response rate of 90.27 %. After primary data cleansing 4 questionnaires had to be omitted. Most of the students opined as “good” or “very good” for the questions on integration and its attributes. Only 27 (44 % were aware of integrated curriculum being taught in other medical schools in the gulf. Similar findings were observed regarding assessment related questions. Reduction in the number of block exams is unpopular among the students and only 6% have agreed for 3, 4, or 5 non-summative block assessments. Opinion regarding the help of integrated teaching in IFOM based OMSB entrance examination was mixed with a greater variance in the responses. 43% students have indicated that they would like to spend more time with PDCI. Conclusion The students of our institution seem to have a favourable opinion regarding the integrated system of teaching. The satisfaction with the conduct of examinations and its related variables is found to be high. A reduction in the number of block exams however is unpopular among the target group and they would appreciate a greater time allocation for subjects of PDCI and Pharmacology.

Full Text Available Nowadays, manufacturers face the challenge of reducing manufacturing cycle time, delivery lead time and inventory reduction. Every organization has its own objectives and its own way of decision making processes. Because of the conflictions among the objectives of each organization and non-integrated decision making processes, there has been a need for a new mechanism, which help to resolve those conflictions and to integrate processes. In the early 1990s, management is a process of integrating and utilizing suppliers, manufacturers, warehouses and retailers, so that goods are produced and delivered at the right quantities and at the right time while minimizing costs as well as satisfying customer requirements. Managing the entire supply chain becomes a key factor for the successful business. Organizations now realize that non-integrated manufacturing processes, nonintegrated distribution processes and poor relationships with suppliers and customers are in adequate for their success. The supply chain areas are affected by the organization’s plan. The organization plan’s impact on the supply chain areas cannot be predicted before its execution. Simulation paves way to evaluate the performance of plans before the execution of the plan. This paper describes the effort of developing a simulation model for the supply chain management in an industry. This article discusses the requirement of supply chain simulation modeling.

The performance requirements of the NASA Space Station have prompted a reexamination of a previously developed integrated waste and water management system that used distillation and catalytic oxydation to purify waste water, and microbial digestion and incineration for waste solids disposal. This system successfully operated continuously for 206 days, for a 4-man equivalent load of urine, feces, wash water, condensate, and trash. Attention is given to synergisms that could be established with other life support systems, in the cases of thermal integration, design commonality, and novel technologies.

Full Text Available Case summary A 7-year-old male castrated domestic short-haired cat was evaluated for a 4 week history of intermittent vomiting, ptyalism, lethargy and weight loss. Serum biochemistry revealed mild mixed hepatopathy. Abdominal ultrasonography identified multiple heterogeneous hepatic masses and a linear, hyperechoic focus with associated reverberation artifact in the wall of the stomach consistent with a gastric ulcer. Serum gastrin concentrations were markedly increased. Cytologic interpretation of a fine-needle aspirate of the hepatic masses was consistent with neuroendocrine neoplasia, and a diagnosis of gastrinoma was established. Deterioration of the cat’s condition, despite at-home acid-suppressant therapy, led to hospitalization. The cat was initially stabilized with intravenous crystalloid fluid therapy, maropitant, pantoprazole and octreotide. A continuous radiotelemetric intragastric pH monitoring system was used to monitor the response of intragastric pH to therapy. Long-term therapy was continued with omeprazole (orally q12h, octreotide (subcutaneously q8h and thrice-weekly toceranib administered orally. Toceranib therapy led to gastrointestinal upset and was discontinued. Gastric ulceration resolved within 8 weeks, and palliation of clinical signs was achieved for approximately 5 months. Relevance and novel information Including this report, only six cases of feline gastrinoma have been reported in the veterinary literature. Little is known regarding non-surgical therapy, and octreotide has not been previously reported for medicalmanagement of feline gastrinoma. Results of intragastric pH monitoring and clinical improvement suggest that medical therapy using octreotide and proton pump inhibitors represents a novel therapeutic option for cats with gastrinoma where surgical excision is not feasible.

Optimal land and water management to address future and current resource stresses and allocation challenges requires the development of state-of-the-art geomatics and hydrological modelling tools. Future hydrological modelling tools should be of high resolution, process based with real-time capability to assess changing resource issues critical to short, medium and long-term enviromental management. The objective here is to merge two renowned, well published resource modeling programs to create an source toolbox for integrated land and water management applications. This work will facilitate a much increased efficiency in land and water resource security, management and planning. Following an 'open-source' philosophy, the tools will be computer platform independent with source code freely available, maximizing knowledge transfer and the global value of the proposed research. The envisioned set of water resource management tools will be housed within 'Whitebox Geospatial Analysis Tools'. Whitebox, is an open-source geographical information system (GIS) developed by Dr. John Lindsay at the University of Guelph. The emphasis of the Whitebox project has been to develop a user-friendly interface for advanced spatial analysis in environmental applications. The plugin architecture of the software is ideal for the tight-integration of spatially distributed models and spatial analysis algorithms such as those contained within the GENESYS suite. Open-source development extends knowledge and technology transfer to a broad range of end-users and builds Canadian capability to address complex resource management problems with better tools and expertise for managers in Canada and around the world. GENESYS (Generate Earth Systems Science input) is an innovative, efficient, high-resolution hydro- and agro-meteorological model for complex terrain watersheds developed under the direction of Dr. James Byrne. GENESYS is an outstanding research and applications tool to address

Full Text Available Fahd Al Qahtani,1 Adel Abdelaziz2,31Radiology Department, Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia; 2Medical Education Development Unit, Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia; 3Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, EgyptAbstract: Fulfilling the goal of integrating radiology into undergraduate medical curricula is a real challenge due to the enduring faith assuming that traditional medical disciplines are worthy of consuming the available study time. In this manner, radiology is addressed occasionally and with relevance to these traditional disciplines. In Al-Baha University Faculty of Medicine, Al-Baha, Saudi Arabia, efforts have been made to integrate radiology vertically and in a structured manner into the undergraduate curriculum from the first year to the sixth year. For achieving convenient integration of radiology, a triphasic approach to integration is adopted. This approach consists of the integration of radiology foundations into the basic sciences phase, development of a distinct 4-week module in year 4, and finally, integration of clinical applications of radiology in the clinical phase modules. Feedback of students and inferences obtained through assessment and program evaluation are in favor of this approach to integration. Minor reform and some improvement related to time allocated and content balancing are still indicated.Keywords: radiology foundations, radiology module, students assessment

Introduction: The IntegratedMedical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed IntegratedMedical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project. Methods: Figure 1 [see document] illustrates the IMM modeling system and scenario process. As illustrated, the IMM computational architecture is based on Probabilistic Risk Assessment techniques. Nineteen assumptions and limitations define the IMM application domain. Scenario definitions include crew medical attributes and mission specific details. The IMM forecasts probabilities of loss of crew life (LOCL), evacuation (EVAC), quality time lost during the mission, number of medical resources utilized and the number and type of medical events by combining scenario information with in-flight, analog, and terrestrial medical information stored in the iMED. In addition, the metrics provide the integrated information necessary to estimate optimized in-flight medical kit contents under constraints of mass and volume or acceptable level of mission risk. Results and Conclusions

The Japanese, through a combination of public policy, private market conditions, a geographic necessity, practice integrated municipal solid waste (MSW) management. The approach of MSW management in Japan is as follows: The basic concept of refuse treatment consists of recycling discharged refuse into usable resources, reusing such resources as much as possible, and then treating or disposing of the usable portion into a sanitary condition. Considering the difficulty of procuring land or seaside areas for such purpose as a refuse disposal site, it will be necessary to minimize the volume of refuse collected for treatment or disposal.

This article discusses how improved management of energy data can bring about the increase in efficiency that is necessary for an electricity enterprise operating in a liberalised electricity market. The relevant technical and business processes involved for a typical power distribution utility are described. The present situation is reviewed and the various physical, data-logistics and commercial 'domains' involved are examined. Possible solutions for energy data logistics and integrated data management are discussed from the points of view of the operating utility, the power supplier and those responsible for balancing out supply and demand

The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

Developments in data collection and retrieval systems to allow timely cost analysis, financial reporting and production management are discussed. One of the most important new OLAP (on-line analytical processing) products is Energy Warehouse which gathers field information from various sources, allows advanced searches, and generates reports previously unavailable in other conventional financial accounting systems. Another OLAP-based system, the Canadian Upstream Energy System (CUES), was developed by the Oracle Corporation and the Calgary-based Applied Terravision Systems (ATS) Inc. CUES combines Oracle's universal data server software development tools with ATS's upstream financial, land, geotechnical and production applications. ATS also developed a product called IDPMARS (Integrated Daily Production Management Accounting Reporting System). It interfaces with CUES to link working interests, government royalties, administration, facility charges, lifting costs, transportation tooling, and customers by integrating field data collection systems with financial accounting

Developments in data collection and retrieval systems to allow timely cost analysis, financial reporting and production management are discussed. One of the most important new OLAP (on-line analytical processing) products is Energy Warehouse which gathers field information from various sources, allows advanced searches, and generates reports previously unavailable in other conventional financial accounting systems. Another OLAP-based system, the Canadian Upstream Energy System (CUES), was developed by the Oracle Corporation and the Calgary-based Applied Terravision Systems (ATS) Inc. CUES combines Oracle`s universal data server software development tools with ATS`s upstream financial, land, geotechnical and production applications. ATS also developed a product called IDPMARS (Integrated Daily Production Management Accounting Reporting System). It interfaces with CUES to link working interests, government royalties, administration, facility charges, lifting costs, transportation tooling, and customers by integrating field data collection systems with financial accounting.

Ontario Hydro is developing an integrated air management plan as a tool for comparing the environmental impacts of fossil-fuel power generation options. The goal is to relate equipment, location, emissions, and impacts and to identify the optimum way to manage the utility's fossil generation system in view of upcoming environmental regulations and public expectations. The eight steps of the plan are briefly described: definition of power generation scenarios (upgrading, conversion to natural gas, non-utility generation, alternative technologies); estimation of emissions for each generation and fuel option studied; identification of impact of air emissions on building materials, agriculture, forests, lakes, and fisheries; modelling of air emissions dispersion; quantification of damage to pollution receptors; quantification of full fuel cycle effects; and comparison of the scenarios. The scenario having the lowest overall environmental impact involved upgrading the existing fossil-fuel system with additional air emissions controls and two integrated gasification combined cycle plants. 9 refs., 3 figs., 3 tabs

This paper identifies work needed by developers to make integrated system health management (ISHM) technology ready and by programs to make mission infrastructure ready for this technology. This paper examines perceptions of ISHM technologies and experience in legacy programs. Study methods included literature review and interviews with representatives of stakeholder groups. Recommendations address 1) development of ISHM technology, 2) development of ISHM engineering processes and methods, and 3) program organization and infrastructure for ISHM technology evolution, infusion and migration.

Bone marrow aplasia is one of the main syndromes following a high dose accidental radiation exposure. Although both transfusion and bone marrow transplantation have been used with some success since the first treatments of patients, other therapeutic strategies are needed. New promising approaches of the treatment of aplasia have appeared with the development of experimental and clinical hematology. Some new trends for the treatment of the hematopoietic injury based on bone marrow transplantation rely on new sources of compatible donor cells, such as cord blood, on the selection of immature haemopoietic cells and on new transplant regimens. The hematopoietic growth factors stimulate proliferation and/or differentiation of hematopoietic progenitors and possibly stem cells. Furthermore, they act on the functions of mature cells. They have now specific uses in hematology, related to their role in the regulation of growth and differentiation of hematopoietic progenitor cells. Some growth factors have already been used for the treatment of accidental radiation-induced aplasia and lessons have been learned from their medicalmanagement and follow-up. (author) 30 refs.

Bone marrow aplasia is one of the main syndromes following a high dose accidental radiation exposure. Whilst transfusion and bone marrow transplantation have been used with some success starting with the first treatments of accident victims, other therapeutic strategies are needed. With the development of experimental and clinical haematology, promising new approaches to the treatment of aplasia have appeared. New trends for the treatment of haemopoietic injury based on bone marrow transplantation rely on new sources of compatible donor cells, such as cord blood, on the selection of immature haemopoietic cells and on new transplant regimens. Haemopoietic growth factors stimulate the proliferation and/or differentiation of haemopoietic progenitors and, possibly, stem cells. Furthermore, they act on the functions of mature cells. Currently, they have specific uses in haematology related to their role in the regulation of growth and in the differentiation of haemopoietic progenitor cells. Growth factors have already been used for the treatment of accidental radiation induced aplasia and lessons have been learned from their medicalmanagement and followup. (author)

Localized exposure resulting in radiation burns are serious injuries, seen not only in this country but all over the world. All of these injuries have resulted from accidents in Industrial Radiography (non-destructive testing). In our country all these injuries have occurred in the private sectors who handle these radiography sources. These sources can be of Iridium-192 or Cobalt-60. Some of these accidents have occurred involving trained radiographers but sometimes casual workers have been exposed. Skin is highly vulnerable to the external radiation exposure. Damage of varying extent can be seen following radiotherapy and accidents involving X- and gamma-ray sources. The reaction is related to the absorbed dose, which in turn is dependent upon the energy of radiation and weather it is particulate or electromagnetic radiation. Beta particles give up their energy within a short range and hence are more hazardous. Radiation burns develop slowly and blister formation occurs usually after 4 weeks. After exposure the skin response occurs in the form of transient erythema, fixed erythema, transepidermal burns, full thickness radiation burns and epilation. In radiation accidents, particularly those involving X-ray machines, the patients may not be aware of the time of accident and the dose may not be known in those circumstances. The medicalmanagement and treatment of such patients, therefore, has its own challenges. This talk will share some experiences on treatment of radiation injuries. (author)

This report is to present the work that was performed during the summer in the Advance Computing Application office. The NFFP (NASA Faculty Fellow Program) had ten summer faculty members working on IVHM (Integrated Vehicle Health Management) technologies. The objective of this project was two-fold: 1) to become familiar with IVHM concepts and key demonstrated IVHM technologies; and 2) to integrate the research that has been performed by IVHM faculty members into the MASTLAB (Marshall Avionic Software Test Lab). IVHM is a NASA-wide effort to coordinate, integrate and apply advanced software, sensors and design technologies to increase the level of intelligence, autonomy, and health state of future vehicles. IVHM is an important concept because it is consistent with the current plan for NASA to go to the moon, mars, and beyond. In order for NASA to become more involved in deep exploration, avionic systems will need to be highly adaptable and autonomous.

Objectives: To select, present, and summarize the best papers published in 2016 in the field of Knowledge Representation and Management (KRM). Methods: A comprehensive and standardized review of the medical informatics literature was performed based on a PubMed query. Results: Among the 1,421 retrieved papers, the review process resulted in the selection of four best papers focused on the integration of heterogeneous data via the development and the alignment of terminological resources. In the first article, the authors provide a curated and standardized version of the publicly available US FDA Adverse Event Reporting System. Such a resource will improve the quality of the underlying data, and enable standardized analyses using common vocabularies. The second article describes a project developed in order to facilitate heterogeneous data integration in the i2b2 framework. The originality is to allow users integrate the data described in different terminologies and to build a new repository, with a unique model able to support the representation of the various data. The third paper is dedicated to model the association between multiple phenotypic traits described within the Human Phenotype Ontology (HPO) and the corresponding genotype in the specific context of rare diseases (rare variants). Finally, the fourth paper presents solutions to annotation-ontology mapping in genome-scale data. Of particular interest in this work is the Experimental Factor Ontology (EFO) and its generic association model, the Ontology of Biomedical AssociatioN (OBAN). Conclusion: Ontologies have started to show their efficiency to integratemedical data for various tasks in medical informatics: electronic health records data management, clinical research, and knowledge-based systems development. Georg Thieme Verlag KG Stuttgart.

he occurrence of esophageal and gastric motor dysfunctions happens, when the software of the esophagus and the stomach is injured. This is really a program previously established in the enteric nervous system as a constituent of the newly called neurogastroenterology. The enteric nervous system is composed of small aggregations of nerve cells, enteric ganglia, the neural connections between these ganglia, and nerve fibers that supply effectors tissues, including the muscle of the gut wall. The wide range of enteric neuropathies that includes esophageal achalasia and gastroparesis highlights the importance of the enteric nervous system. A classification of functional gastrointestinal disorders based on symptoms has received attention. However, a classification based solely in symptoms and consensus may lack an integral approach of disease. As an alternative to the Rome classification, an international working team in Bangkok presented a classification of motility disorders as a physiology-based diagnosis. Besides, the Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high-resolution esophageal pressure topography studies. This review covers exclusively the medical and surgical management of the esophageal and gastric motor dysfunction using evidence from well-designed studies. Motor control of the esophagus and the stomach, motor esophageal and gastric alterations, treatment failure, side effects of PPIs, overlap of gastrointestinal symptoms, predictors of treatment, burden of GERD medicalmanagement, data related to conservative treatment vs. antireflux surgery, and postsurgical esophagus and gastric motor dysfunction are also taken into account.

facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners' orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers' orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medicationmanagement systems, in which prescribers' electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility's pharmacy, could improve patient safety.

The IntegratedMedical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The IntegratedMedical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

The IntegratedMedical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The IntegratedMedical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment.

Effective management of area-wide integrated pest management (AW-IPM) programmes that integrate the sterile insect technique (SIT) is key to success. Programme planning includes collection of baseline data and a feasibility assessment. The optimal management structure is where the programme can be implemented effectively and flexibly, independent of government politics, bureaucracy, and even corruption that impede timely goal achievement. Ideally, programmes include both public and private management, and require strong and steady financial support. Governments and donors are the most common sources of funds, but a mixture of public, community, and private funds is now the trend. Interrupted cash flow severely restrains programme performance. Physical support of programme operations must be reliable, and led by a maintenance professional. It is essential to have full-time, well-paid, and motivated staff led by a programme manger with technical and management experience. Programme failure is usually due to poor management and inadequate public support, and not to poor technology. (author)

Full Text Available Objectives: There is ongoing concern that psychiatric medicationmanagement appointments add little value to care. The present study attempted to address this concern by capturing depressed patients’ views and opinions about the value of psychiatric medicationmanagement appointments. Methods: Seventy-eight semi-structured interviews were performed with white and African American depressed patients post medicationmanagement appointments. These interviews tapped patients’ views and opinions about the value of attending medicationmanagement appointments. Analysis: An iterative thematic analysis was performed. Findings: Patients reported greater appointment value when appointments included obtaining medications, discussing the need for medication changes or dose adjustments, and discussing the impact of medications on their illness. Additionally, greater appointment value was perceived by patients when there were non-medical conversations about life issues, immediate outcomes from the appointment such as motivation to continue in care, and specific qualities of providers that were appealing to patients. Conclusions: Patients’ perceived value of psychiatric medicationmanagement appointments is complex. Though important patient outcomes are obtaining medicine and perceiving improvement in their mental health, there are other valued appointment and provider factors. Some of these other valued factors embedded within medicationmanagement appointments could have therapeutic properties. These findings have implications for future clinical research and service delivery.

A management systems approach to pipeline integrity was discussed in terms of accident causation models, lessons from accidents, and management systems. Accident causation models include the Heinrich domino theory; epidemiological models; event chain models; and system-based models. A review of the Bellingham pipeline accident showed that if the pipeline had not been weakened by external damage, it likely would have been able to withstand the pressure that occurred on the day of the rupture, and the accident would not have happened. It was also determined that there was inadequate inspection of excavation work during the water treatment plant project and consequently, there was a failure to identify and repair the damage done to the pipeline. The presentation also addressed other findings, such as inaccurate evaluation of in-line pipeline inspection data; failure to manage and protect the supervisory control and data acquisition system (SCADA); and ineffective management oversight of construction and activation of products terminal. The Carlsbad pipeline explosion was also presented as another example of an accident. Several violations by El Paso were cited, including failure to ensure that qualified personnel performed internal corrosion control procedures; failure to perform necessary tests for corrosion; and failure to follow procedures for continuing surveillance of its facilities. Last, the presentation provided a definition of management systems and discussed the characteristics and elements of a management system. These elements included policy and leadership commitment; organizational structure and responsibilities; management of resources; communication plan; document and records management; operational controls; management of change; and continual improvement. 1 fig.

Full Text Available The Integrated Digital Special Collections (INDI system is a prototype of a database-driven, Web application designed to automate and manage archival workflow for large institutions and consortia. This article discusses the how the INDI project enabled the successful implementation of a process to manage large technology projects in the Harold B. Lee Library at Brigham Young University. It highlights how the scope of these technology projects is set and how the major deliverables for each project are defined. The article also talks about how the INDI system followed the process and still failed to be completed. It examines why the process itself is successful and why the INDI project failed. It further underscores the importance of process management in archival management systems.

The usage of basic regulations of logistics in practical activity for providing joints and military units with medical asset is theoretically justified. The role of logistics in organizing, building and functioning of military (armed forces) medical supply system is found out. The methods of solving urgent problems of improvement the resources management of medical asset on the basis of logistics are presented.

Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.

Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the â€˜top 8-12â€™ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in ...

Full Text Available Purpose. The goal of the paper is to discuss the potential benefits and to highlight the drawbacks of integratedmanagement system for organizations that seek to improve management process.Methodology. Methods of the research were used: analysis of a scientific and special literature that presents the requirements, models and results of integratedmanagement systems studies, and analysis of statistical data to assess actuality of integratedmanagement systems for enterprises in Lithuania.Findings. Summarizing research findings, it should be stated that the implementation of management system integration should be based on provision of social responsibility and holistic approach to the organization. It requires the long-term united efforts of leaders in a strategic hierarchical level and high organizational maturity to ensure the fluency of the running stages of planning management system integration, preparing documentations, implementing and realizing integratedmanagement system. Also it is necessary to purify the conception of integratedmanagement system in organizational context. Theoretical analysis of integratedmanagement systems show, that all of the management systems can not be well integrated in principle. They can only be partly integrated and coordinated. A need to question the level of integration of management systems is very important as in scientific discourse as in practice. It is important to mark, that the number of organizations, that seek to optimize management processes by implementing the integratedmanagement systems is rapidly increasing in Lithuania, too. It shows that benefit associated with integration of management systems is apprehensible in Lithuania. Advantages of integratedmanagement systems can certainly become even stronger if scientists and practicians join their forces in search of methods of organizational management development.Research limitations. The research limitations related to a lack of

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.

Jan 1, 2012 ... Book cover Integrated Natural Resource Management in the ... with the common goal of implementing an integrated approach to natural resource ... and the International Water Management Institute in Addis Ababa, Ethiopia.

This concept of operations (Con Ops) for the US-75 Integrated Corridor Management (ICM) Program has been developed as part of the US : Department of Transportation Integrated Corridor Management Initiative, which is an innovative research initiative ...

Full Text Available Purpose. The goal of the paper is to discuss the potential benefits and to highlight the drawbacks of integratedmanagement system for organizations that seek to improve management process.Methodology. Methods of the research were used: analysis of a scientific and special literature that presents the requirements, models and results of integratedmanagement systems studies, and analysis of statistical data to assess actuality of integratedmanagement systems for enterprises in Lithuania.Findings. Summarizing research findings, it should be stated that the implementation of management system integration should be based on provision of social responsibility and holistic approach to the organization. It requires the long-term united efforts of leaders in a strategic hierarchical level and high organizational maturity to ensure the fluency of the running stages of planning management system integration, preparing documentations, implementing and realizing integratedmanagement system. Also it is necessary to purify the conception of integratedmanagement system in organizational context. Theoretical analysis of integratedmanagement systems show, that all of the management systems can not be well integrated in principle. They can only be partly integrated and coordinated. A need to question the level of integration of managementsystems is very important as in scientific discourse as in practice. It is important to mark, that the number of organizations, that seek to optimize management processes by implementing the integratedmanagement systems is rapidly increasing in Lithuania, too. It shows that benefit associated with integration of management systems is apprehensible in Lithuania. Advantages of integratedmanagement systems can certainly become even stronger if scientists and practicians join their forces in search of methods of organizational management development.Research limitations. The research limitations related to a lack of integrated

Full Text Available Medical services are the most important services of all since we all depend on them. Their quality and productivity can assure a wealthy nation and therefore good economical results. The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the “how to” method of obtaining the desired result. The same approach can be applied into our study in order to reach more productive medical services which to prove high quality to all patients. We need to use and to squeeze the entire force of management tools in order to reach our goal: accessible medical services full of quality. The current worldwide crisis situation makes us think that after job and food, even medical services (also a basic thing after all can become a “luxury” although this should never happen. Therefore we must do whatever needed to improve the way medical organizations are driven so that the quality of their medical services will be better and better and the productivity will be at a higher level. Medicalmanagement should have as a goal making it possible for patients to be able to solve their health problems as soon as possible and as good as possible.

Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.

Intensive cropping with no return of crop residues and other organic inputs result in the loss of soil organic matter (SOM) and nutrient supply in (Desi) cotton-wheat cropping system in Pakistan. For appraisal of problem and finding solution to sustainability, we evaluated six treatments comprised of two fertilizer doses and three management techniques over a period of three years (2003-05) monitoring their effects on seed cotton yield and soil fertility. The techniques included chemical fertilizers, municipal solid waste manure (MSWM) integrated with chemical fertilizers in 1:4 ratios with, and without pesticides. The results revealed that cotton yields. Were enhanced by 19% due to site-specific fertilizer dose over conventional dose. Ignoring weeds control by means of herbicided application resulted in 5% decrease of seed cotton yield in IPNM technique positive effect of MSWM integration was noted on soil test phosphorus and SOM. Site-specific fertilizer application and integrated plant nutrient management by MSWM proved their suitability as the techniques not only improve soil quality in terms of sustained levels of organic matter and phosphorus but also provide a safe way of waste disposal. (author)

The IntegratedMedical Model (IMM) Project has been developing a probabilistic risk assessment tool, the IMM, to help evaluate in-flight crew health needs and impacts to the mission due to medical events. This package is a follow-up to a data package provided in June 2009. The IMM currently represents 83 medical conditions and associated ISS resources required to mitigate medical events. IMM end state forecasts relevant to the ISS PRA model include evacuation (EVAC) and loss of crew life (LOCL). The current version of the IMM provides the basis for the operational version of IMM expected in the January 2011 timeframe. The objectives of this data package are: 1. To provide a preliminary understanding of medical risk data used to update the ISS PRA Model. The IMM has had limited validation and an initial characterization of maturity has been completed using NASA STD 7009 Standard for Models and Simulation. The IMM has been internally validated by IMM personnel but has not been validated by an independent body external to the IMM Project. 2. To support a continued dialogue between the ISS PRA and IMM teams. To ensure accurate data interpretation, and that IMM output format and content meets the needs of the ISS Risk Management Office and ISS PRA Model, periodic discussions are anticipated between the risk teams. 3. To help assess the differences between the current ISS PRA and IMM medical risk forecasts of EVAC and LOCL. Follow-on activities are anticipated based on the differences between the current ISS PRA medical risk data and the latest medical risk data produced by IMM.

Introductions: Medication error is one of many types of errors that could decrease the quality and safety of healthcare. Increasing number of adverse events (AE) reflects the number of medication errors. This study aimed to develop a model of medication error prevention based on knowledge management. This model is expected to improve knowledge and skill of nurses to prevent medication error which is characterized by the decrease of adverse events (AE). Methods: This study consisted of two sta...

The contemporary social economic conditions dictate the necessity to change tactics and strategy of functioning of medical institutions of different property forms. Marketing, alongside with management is to become a leading concept of administration of medical institutions. It should be a framework for systematic collection, registration and analysis of data relevant to the medical services market. The issues of the implementation of marketing concept in the practical everyday activities of commercial medical organization providing cosmetology services to population of metropolis.

To get funding approved for medical device integration, ClOs suggest focusing on specific patient safety or staff efficiency pain points. Organizations that make clinical engineering part of their IT team report fewer chain-of-command issues. It also helps IT people understand the clinical goals because the engineering people have been working closely with clinicians for years. A new organization has formed to work on collaboration between clinical engineers and IT professionals. For more information, go to www.ceitcollaboration.org. ECRI Institute has written a guide to handling the convergence of medical technology and hospital networks. Its "Medical Technology for the IT Professional: An Essential Guide for Working in Today's Healthcare Setting" also details how IT professionals can assist hospital technology planning and acquisition, and provide ongoing support for IT-based medical technologies. For more information, visit www.ecri.org/ITresource.

The paper examines progress towards integrated catchment management and sustainable agriculture at Whaingaroa (Raglan), New Zealand. Application of the Canadian "Atlantic Coastal Action Program" model (ACAP) has been only partially successful within New Zealand's bicultural setting. Even before the introduction of the ACAP process there existed strong motivation and leadership by various sectors of the community. A merging of resource management planning and implementation processes of the larger community and that of the Maori community has not occurred. Research carried out by Crown Research Institutes has clearly shown the actions required to make pastoral farming more sustainable. There are difficulties in the transference to, and uptake of, these techniques by farmers. An examination of the socio-economic context is required. There has been a requirement on local government bodies to tighten their focus as part of recent reform. This has occurred concurrently with a widening of vision towards integrated and sustainable forms of management. This (as well as a clear belief in empowerment of local communities) has lead to Council reliance on voluntary labour. There is a need to account for the dynamic interaction between social and political history and the geological and biophysical history of the area. As part of a re-examination of sustainable development, New Zealand needs to reconcile the earning of the bulk of its foreign income from primary production, with the accelerating ecological deficit that it creates. A sustainability strategy is required linking consumer demand, property rights and responsibilities.

The complexity of the heterogeneous computing resources, services and recurring infrastructure changes at the GridKa WLCG Tier-1 computing center require a structured approach to configuration management and optimization of interplay between functional components of the whole system. A set of tools deployed at GridKa, including Puppet, Redmine, Foreman, SVN and Icinga, provides the administrative environment giving the possibility to define and develop configuration workflows, reduce the administrative effort and improve sustainable operation of the whole computing center. In this presentation we discuss the developed configuration scenarios implemented at GridKa, which we use for host installation, service deployment, change management procedures, service retirement etc. The integration of Puppet with a project management tool like Redmine provides us with the opportunity to track problem issues, organize tasks and automate these workflows. The interaction between Puppet and Redmine results in automatic updates of the issues related to the executed workflow performed by different system components. The extensive configuration workflows require collaboration and interaction between different departments like network, security, production etc. at GridKa. Redmine plugins developed at GridKa and integrated in its administrative environment provide an effective way of collaboration within the GridKa team. We present the structural overview of the software components, their connections, communication protocols and show a few working examples of the workflows and their automation.

The world is at a turning point, moving away from the Cold War nuclear legacy towards a future global nuclear enterprise; and this presents a transformational challenge for nuclear materials management. Achieving safety and security during this transition is complicated by the diversified spectrum of threat 'players' that has greatly impacted nonproliferation, counterterrorism, and homeland security requirements. Rogue states and non-state actors no longer need self-contained national nuclear expertise, materials, and equipment due to availability from various sources in the nuclear market, thereby reducing the time, effort and cost for acquiring a nuclear weapon (i.e., manifestations of latency). The terrorist threat has changed the nature of military and national security requirements to protect these materials. An Integrated Global Nuclear Materials Management (IGNMM) approach would address the existing legacy nuclear materials and the evolution towards a nuclear energy future, while strengthening a regime to prevent nuclear weapon proliferation. In this paper, some preliminary concepts and studies of IGNMM will be presented. A systematic analysis of nuclear materials, activities, and controls can lead to a tractable, integrated global nuclear materials management architecture that can help remediate the past and manage the future. A systems approach is best suited to achieve multi-dimensional and interdependent solutions, including comprehensive, end-to-end capabilities; coordinated diverse elements for enhanced functionality with economy; and translation of goals/objectives or standards into locally optimized solutions. A risk-informed basis is excellent for evaluating system alternatives and performances, and it is especially appropriate for the security arena. Risk management strategies--such as defense-in-depth, diversity, and control quality--help to weave together various technologies and practices into a strong and robust security fabric. Effective

Nowadays, only closed and proprietary integrated operating room systems (IORS) from big manufacturers are available on the market. Hence, the interconnection of components from third-party vendors is only possible with increased time and costs. In the context of the German Federal Ministry of Education and Research (BMBF)-funded project OR.NET (2012-2016), the open integration of medical devices from different manufacturers was addressed. An integrated operating theater based on the open communication standard IEEE 11073 shall give clinical operators the opportunity to choose medical devices independently of the manufacturer. This approach would be advantageous especially for hospital operators and small- and medium-sized enterprises (SME) of medical devices. Actual standards and concepts regarding technical feasibility and the approval process do not cope with the requirements for a modular integration of medical devices in the operating room (OR), based on an open communication standard. Therefore, innovative approval strategies and corresponding certification and test procedures, which cover actual legal and normative standards, have to be developed in order to support the future risk management and the usability engineering process of open integratedmedical devices in the OR. The use of standardized device and service profiles and a three-step testing procedure, including conformity, interoperability and integration tests are described in this paper and shall support the manufacturers to integrate their medical devices without disclosing the medical devices' risk analysis and related confidential expertise or proprietary information.

Full Text Available Water management within the cropping system is a key factor for an integrated weed management. Soil moisture affects seed persistence and seed dormancy, thus influencing their germination, the establishment of seedlings as well as the competition at adult stage and the number, vitality and dormancy of the new seeds produced by the weeds. The interactions among water availability and competition are very complex and still not fully understood. A research effort in this sector should the be very relevant for the development of new approaches of weed management, such as “Ecological weed management”, aiming to reduce weed density and competitiveness and, in the medium term, to prevent undesired modifications of the weed flora.

The need to easily access pipeline information and the increasing number of inspections using distinct techniques from different vendors makes the use of systems in the IntegrityManagement Program indispensable. For this reason, MOPI has been developed by two Brazilian companies, Pipeway Engenharia in partnership with Minds at Work. This tool allows data recording from the design, construction and operation of the pipeline, the storage of documents, the comparison between the results of different inspections, the planning inspections, contracts and maintenance of the pipeline. Furthermore, the information registered in the system can be accessed by a network user without limitation of time or number of users. This work presents the main details and features of MOPI. (author)

Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.

To identify doctors' utilization of ICT; to develop and characterise a typology of doctors' utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice. An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken. Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as 'integrated doctors'. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled 'non-integrated doctors'. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an 'integrated doctor'. The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands. 2010 Elsevier Ireland Ltd. All rights reserved.

Full Text Available stream_source_info Department of Environmental Affairs and Tourism_2004.pdf.txt stream_content_type text/plain stream_size 70155 Content-Encoding ISO-8859-1 stream_name Department of Environmental Affairs and Tourism_2004.pdf... and Tourism Other topics in the series of overview information documents on the concepts of, and approaches to, integrated environmental management are listed below. Further titles in this series are being prepared and will be made available periodically...

FEMA is implementing a computerized system for use in optimizing planning, and for supporting exercises of these plans. Called the Integrated Emergency Management Information System (IEMIS), it consists of a base geographic information system upon which analytical models are superimposed in order to load data and report results analytically. At present, it supports FEMA's work in offsite preparedness around nuclear power stations, but is being developed to deal with a full range of natural and technological accident hazards for which emergency evacuation or population movement is required

Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

The information management of medical materials by using high-tech computer, in order to improve the efficiency of the consumption of medical supplies, hospital supplies and develop a new technology way to manage the hospital and material support. Using C # NET, JAVA techniques to develop procedures for the establishment of hospital material management information system, set the various management modules, production of various statistical reports, standard operating procedures. The system is convenient, functional and strong, fluent statistical functions. It can always fully grasp and understand the whole hospital supplies run dynamic information, as a modern and effective tool for hospital materials management.

The subject document reports the results of an in-depth investigation of the fiscal year 1992 cost of the City of Seattle, Washington, integrated municipal solid waste management (IMSWM) system, the energy consumed to operate the system, and the environmental performance requirements for each of the system`s waste-processing and disposal facilities. Actual data from records kept by participants is reported in this document. Every effort was made to minimize the use of assumptions, and no attempt is made to interpret the data reported. Analytical approaches are documented so that interested analysts may perform manipulation or further analysis of the data. As such, the report is a reference document for MSW management professionals who are interested in the actual costs and energy consumption for a one-year period, of an operating IMSWM systems.

The subject document reports the results of an in-depth investigation of the fiscal year 1992 cost of the City of Minneapolis, Minnesota (Hennepin County) integrated municipal solid waste management (IMSWM) system, the energy consumed to operate the system, and the environmental performance requirements for each of the system`s waste-processing and disposal facilities. Actual data from records kept by participants is reported in this document. Every effort was made to minimize the use of assumptions, and no attempt is made to interpret the data reported. Analytical approaches are documented so that interested analysts may perform manipulation or further analysis of the data. As such, the report is a reference document for municipal solid waste (MSW) management professionals who are interested in the actual costs and energy consumption for a one-year period, of an operating IMSWM system.

The subject document reports the results of an in-depth investigation of the fiscal year 1992 cost of the City of Sevierville, Tennessee integrated municipal solid waste management (IMSWM) system, the energy consumed to operate the system, and the environmental performance requirements for each of the system`s waste-processing and disposal facilities. Actual data from records kept by participants is reported in this document. Every effort was made to minimize the use of assumptions, and no attempt is made to interpret the data reported. Analytical approaches are documented so that interested analysts may perform manipulation or further analysis of the data. As such, the report is a reference document for MSW management professionals who are interested in the actual costs and energy consumption for a one-year period, of an operating IMSWM systems.

Changes in the power generating industry continue apace. The effects of privatisation are widely visible: nowhere more so than in the growing national and international competition facing the generators around the world. A successful, long-term marriage between generator and contractor on power station outage management offers significant scope for cost reduction, shortening annual plant downtime and generating more megawatts, all within a safety environment of continuous improvement. Working in close partnership, Nuclear Electric and Rolls-Royce Nuclear Engineering Services have remodelled the whole contractor/client strategy. The new discipline, known as integrated outage management and partnering, is already producing shorter outage periods at Bradwell, a Magnox Station in Essex. (author)

Abstract Background Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS). Medicationmanagement is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore ...

Full Text Available Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the â€˜top 8-12â€™ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in the area and the professional expertise, this article outlines an integrated approach to risk assessment and risk management reporting processes, by separating the risk in two main categories: strategic and operational risks. The focus is on risk prioritization and scoring; the final output will comprise a mix of strategic and operational (â€˜top 8-12â€™ risks, which should be used to establish the annual Internal Audit plan. Originality/value: By using an integrated approach to risk assessment and risk management will eliminate the need for a separate Internal Audit risk assessment over prevailing risks. It will reduce the level of risk assessment overlap by different functions (Tax, Treasury, Information System over the same risk categories as a single methodology, is used and will align timings of risk assessment exercises. The risk prioritization by usage of risk and control scoring criteria highlights the combination between financial and non-financial impact criteria allowing risks that do not naturally lend themselves to a financial amount to be also assessed consistently. It is emphasized the usage of score method to prioritize the risks included in the annual audit plan in order to increase accuracy and timelines.

The Japanese, through a combination of public policy, private market conditions, and geographic necessity, practice integrated municipal solid waste management as defined by the US Environmental Protection Agency. The Japanese have not defined a specific hierarchical preference for alternative waste management practices, i.e., waste reduction, reuse and recycling, combustion, composting, and landfill disposal. However, in marked contrast to the US approach, the Japanese system relies heavily on waste combustion, with and without energy recovery. {open_quotes}Discards{close_quotes}, as the term is used in this paper, refers to all materials considered used and spent by residential and commercial generators. That which is discarded (whether recyclable or nonrecyclable) by a municipality is referred to as MSW. This paper provides an overview of MSW management practices and private-sector recycling in Japan. Estimates of the total generation of residential and commercial discards and their disposition are also presented. Such an overview of Japanese practices can be used to assess the potential effectiveness of US integrated solid waste management programs. Of the estimated 61.3 to 72.1 million tons of residential and commercial discards generated in Japan during its 1989 fiscal year (April 1, 1989, through March 31, 1990), an estimated 55 to 64 percent was incinerated; 15 to 28 percent was recycled (only 2 to 3 percent through municipal recycling activities); less than 0.1 percent was composted or used as animal feed; and 17 to 20 percent was landfilled. Including ash disposal, 26 to 30 percent, by weight, of the gross discards were landfilled.

Integratingmedical instruments with medical information systems becomes more and more important in healthcare industry. To make medical instruments without standard communication interface possess the capability of interoperating and sharing information with medical information systems, we developed a medical instrument integration gateway based on Integrating the Healthcare Enterprise Patient Care Device (IHE PCD) integration profiles in this research. The core component is an integration engine which is implemented according to integration profiles and Health Level Seven (HL7) messages defined in IHE PCD. Working with instrument specific Javascripts, the engine transforms medical instrument data into HL7 ORU message. This research enables medical instruments to interoperate and exchange medical data with information systems in a standardized way, and is valuable for medical instrument integration, especially for traditional instruments.

The management process of Integrated Water Resources Management (IWRM) consists of aspects of policies/strategies, measures (engineering measures and non-engineering measures) and organizational management structures, etc., among which engineering measures such as reservoirs, dikes, canals, etc., play the backbone that enables IWRM through redistribution and reallocation of water in time and space. Engineering measures are usually adopted for different objectives of water utilization and water disaster prevention, such as flood control and drought relief. The paper discusses the planning and implementation of engineering measures in IWRM of the Changjiang River, China. Planning and implementation practices of engineering measures for flood control and water utilization, etc., are presented. Operation practices of the Three Gorges Reservoir, particularly the development and application of regulation rules for flood management, power generation, water supply, ecosystem needs and sediment issues (e.g. erosion and siltation), are also presented. The experience obtained in the implementation of engineering measures in Changjiang River show that engineering measures are vital for IWRM. However, efforts should be made to deal with changes of the river system affected by the operation of engineering measures, in addition to escalatory development of new demands associated with socio-economic development.

Full Text Available The management process of Integrated Water Resources Management (IWRM consists of aspects of policies/strategies, measures (engineering measures and non-engineering measures and organizational management structures, etc., among which engineering measures such as reservoirs, dikes, canals, etc., play the backbone that enables IWRM through redistribution and reallocation of water in time and space. Engineering measures are usually adopted for different objectives of water utilization and water disaster prevention, such as flood control and drought relief. The paper discusses the planning and implementation of engineering measures in IWRM of the Changjiang River, China. Planning and implementation practices of engineering measures for flood control and water utilization, etc., are presented. Operation practices of the Three Gorges Reservoir, particularly the development and application of regulation rules for flood management, power generation, water supply, ecosystem needs and sediment issues (e.g. erosion and siltation, are also presented. The experience obtained in the implementation of engineering measures in Changjiang River show that engineering measures are vital for IWRM. However, efforts should be made to deal with changes of the river system affected by the operation of engineering measures, in addition to escalatory development of new demands associated with socio-economic development.

Full Text Available This paper investigates ways to deal with the uncertainties in fishing trawler scheduling and production planning in a quota-based integrated commercial fishery. A commercial fishery faces uncertainty mainly from variation in catch rate, which may be due to weather, and other environmental factors. The firm tries to manage this uncertainty through planning co-ordination of fishing trawler scheduling, catch quota, processing and labour allocation, and inventory control. Scheduling must necessarily be done over some finite planning horizon, and the trawler schedule itself introduces man-made variability, which in turn induces inventory in the processing plant. This induced inventory must be managed, complicated by the inability to plan easily beyond the current planning horizon. We develop a surprisingly simple innovation in inventory, which we have not seen in other papers on production management, which of requiring beginning inventory to equal ending inventory. This tool gives management a way to calculate a profit-maximizing safety stock that counter-acts the man-made variability due to the trawler scheduling. We found that the variability of catch rate had virtually no effects on the profitability with inventory. We report numerical results for several planning horizon models, based on data for a major New Zealand fishery.

This paper introduces the planning construction of integrative schedule management for Nuclear Power Project. It details schedule management system and the requirement of schedulers and the mode of three schedule management flats. And analysis it combing with the implementation of construction water and all special schedules before FCD to further propose the improving and researching direction for the integrative schedule management. (authors)

Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

Once the decision has been made to adopt an integratedmedical information system (IMIS), there are a number of tissues to overcome. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. The purpose of this study is to investigate the benefits and unexpected problems encountered in the implementation of IMIS and to determine a useful framework for IMIS. The Yonsei University Dental Hospital is steadily constructing an IMIS. The vendor's PACS software, Piview STAR, supports transactions between workstations that are approved to integrating the health care enterprise (IHE) with security function. It is necessary to develop an excellent framework that is good for the patient, health care provider and information system vendors, in an expert, efficient, and cost-effective manner. The problems encountered with IMIS implementation were high initial investments, delay of EMR enforcement, underdevelopment of digital radiographic appliances and software and insufficient educational training for users. The clinical environments of dental IMIS is some different from the medical situation. The best way to overcome these differences is to establish a gold standard of dental IMIS integration, which estimates the cost payback. The IHE and its technical framework are good for the patient, the health care provider and all information systems vendors.

Supplier selection is considered as one of the most critical issues encountered by operations and purchasing managers to sharpen the company’s competitive advantage. In this paper, a novel fuzzy multi-criteria group decision making approach integrating quality function deployment (QFD) and decision making trial and evaluation laboratory (DEMATEL) method is proposed for supplier selection. The proposed methodology enables to consider the impacts of inner dependence among supplier assessment cr...

Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.

Full text: Full text: In the Bangladesh Poverty Reduction Strategy (PRSP), Millennium Development Goals and other donor driven initiatives, two vital areas linked with poverty and ecosystem survival seem to be either missing or are being neglected: (a) transboundary water use and (b) coastal area poverty and critical ecosystems vulnerable due to climate change. Since the World Summit on Sustainable Development (WSSD) goals and PRSP are integrated, it is necessary that the countrys WSSD goals and PRSP should also be in harmony. All should give the recognition of Ganges Brahmaputra and Meghna as international basins and the approach should be taken for regional sustainable and integrated water resource management involving all co-riparian countries. The principle of low flow in the international rivers during all seasons should be ensured. All stakeholders should have a say and work towards regional cooperation in the water sector as a top priority. The energy sector should be integrated with water. The Indian River Linking project involving international rivers should be seriously discussed at all levels including the parliament so that voice of Bangladesh is concerted and information shared by all concerned. One of the most critical challenges Bangladesh faces is the management of water resources during periods of water excesses and acute scarcity. It is particularly difficult when only 7% of the catchments areas of the very international rivers, the Ganges, the Brahmaputra and the Meghna are in Bangladesh while 97% is outside Bangladesh where unfortunately, Bangladesh has no control on upstream diversion and water use. The UN Conference on Environment and Development in its Agenda 21 emphasizes the importance of Integrated Water Resource Management (IWRM). The core point of IWRM is that is development of all aspects of entire basin in a basin wide approach, that all relevant agencies of the government and water users must be involved in the planning process and

Effective Space Asset Management is one key to addressing the ever-growing issue of space congestion. It is imperative that agencies around the world have access to data regarding the numerous active assets and pieces of space junk currently tracked in orbit around the Earth. At the center of this issues is the effective management of data of many types related to orbiting objects. As the population of tracked objects grows, so too should the data management structure used to catalog technical specifications, orbital information, and metadata related to those populations. Marshall Space Flight Center's Space Asset Management Database (SAM-D) was implemented in order to effectively catalog a broad set of data related to known objects in space by ingesting information from a variety of database and processing that data into useful technical information. Using the universal NORAD number as a unique identifier, the SAM-D processes two-line element data into orbital characteristics and cross-references this technical data with metadata related to functional status, country of ownership, and application category. The SAM-D began as an Excel spreadsheet and was later upgraded to an Access database. While SAM-D performs its task very well, it is limited by its current platform and is not available outside of the local user base. Further, while modeling and simulation can be powerful tools to exploit the information contained in SAM-D, the current system does not allow proper integration options for combining the data with both legacy and new M&S tools. This paper provides a summary of SAM-D development efforts to date and outlines a proposed data management infrastructure that extends SAM-D to support the larger data sets to be generated. A service-oriented architecture model using an information sharing platform named SIMON will allow it to easily expand to incorporate new capabilities, including advanced analytics, M&S tools, fusion techniques and user interface for

Historically, clinical medical education has relied on subjective evaluations of students and residents to judge their clinical competence. The uncertainty associated with these subjective clinical evaluations has produced evaluation apprehension among learners and attempts to manage one's professional persona (impression management) among peers and supervisors. Such behavior has been documented from antiquity through the Middle Ages to the present, including in two new qualitative studies in this issue of Academic Medicine on the social psychology of clinical medical education. New approaches to medical education, including competency-based education, mastery learning, and assessment methods that unite evaluation and education, are slowly changing the culture of clinical medical education. The author of this Invited Commentary argues that this shift will bring greater transparency and accountability to clinical medical education and gradually reduce evaluation apprehension and the impression management motives it produces.

Medical emergencies can happen in the dental office, possibly threatening a patient's life and hindering the delivery of dental care. Early recognition of medical emergencies begins at the first sign of symptoms. The basic algorithm for management of all medical emergencies is this: position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D). The dentist places an unconscious patient in a supine position and comfortably positions a conscious patient. The dentist then assesses airway, breathing and circulation and, when necessary, supports the patient's vital functions. Drug therapy always is secondary to basic life support (that is, PABCD). Prompt recognition and efficient management of medical emergencies by a well-prepared dental team can increase the likelihood of a satisfactory outcome. The basic algorithm for managingmedical emergencies is designed to ensure that the patient's brain receives a constant supply of blood containing oxygen.

This article considers the pragmatic aspects of conducting a situation/marketing audit for group medical practices. This audit is a key component in the formulation of a competitive strategy and the development of a marketing program. Given are a series of questions that may be used by medical groups to guide assessment of the opportunities and threats present in the environment as well as the strengths and weaknesses of the organization in meeting the environmental challenges. Furthermore, the article provides a framework for thinking about strategy and the variables that should be considered and aligned to achieve effective implementation of strategy. Finally, the parameters are outlined for deciding on a marketing program: the mix of marketing tools (service design, distribution channels, pricing and promotion) that should be employed to offensively and/or defensively position the medical group in the competitive marketplace.

Full Text Available The adoption of Product Life-cycle Management Systems (PLMs concept is fundamental to improve the product development, mainly to small and medium enterprises (SMEs. One of the challenges is the integration between project management and product data management functions. The paper presents an analysis of the potential integration strategies for a specifics product data management system (SMARTEAM and a project management system (Microsoft Project, which are commonly used for SMEs. Finally the article presents some considerations about the study of Project Management solutions in SMB’s companies, considering the PLM approach. Key-words: integration, project management (PM, workflow, PDM, PLM.

medicalmanagement options, their advantages or disadvantages, their clinical application ..... (irritability, sadness) and the rebound effect, where children appear to be even worse in the ..... The latter fear has been put to rest.67,68 One recent ...

African Journal of Environmental Science and Technology ... evaluation of medical waste management systems was conducted in the low-level health ... In Ilala, 70% of the health facilities burn wastes in poorly designed incinerators, open pit ...

Since September 1992, attempts have been made at Kagoshima University Hospital to develop the Medical Material Distribution Management System which helps to realize optimal hospital management as a subsystem of the Total Hospital Information System of Kagoshima University (THINK). As this system has been established, it has become possible for us to have an accurate grasp of the flow and stock of medical materials at our hospital. Furthermore, since September 1993, the Medical Material Distribution Management System has been improved and the Total Medical Material Distribution Management System has been smoothly introduced into the site of clinical practice. This system enables automatic demands for fees for treatment with specific instruments and materials covered by health insurance. It was difficult to predict the effect of this system, because no similar system had been developed in Japan. However, more satisfactory results than expected have been obtained since its introduction.

We aimed to determine UK medical students' perceptions and attitudes and interest toward medical leadership and clinician managers. A cross-sectional study was conducted during the academic year 2015-2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree) when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership training they received during medical school as "very poor" or "poor" (54.4%). Our study suggests that UK medical students have an appetite for management and leadership training and appreciate its importance but feel that the training they are receiving is poor. This suggests that there is a gap between the demand for management and leadership training and the quality of training supplied by UK medical schools.

OBJECTIVE:Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person.We implemented a longitudinal IM short-course curriculum into our medical school education.This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.METHODS:A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies.Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school.Paired data analysis was done,and only students who completed surveys at both time points were included in final analyses.RESULTS:Of 52 students in each class,17 (33％) in the class of 2015 and 22 (42％) in the class of 2016 completed both surveys.After the IM curriculum,students' knowledge of and comfort with several IM therapies—biofeedback,mindfulness,and the use of St.John's wort—improved significantly.Students' personal health practices also improved,including better sleep,exercise,and stress management for the class of 2015.Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.CONCLUSION:It is feasible to incorporate IM education into undergraduate medical education,and this is associated with improvement in students' knowledge of IM and personal health practices.

The maintenance department in a hospital is responsible for ensuring the safety of medical equipment and their availability while keeping the operation costs minimal. The selection of the best maintenance strategy is a key decision to reduce the equipment downtime, increase the availability, and

The practice of medicine has become increasingly complex in this era of diagnosis-related groups (DRGs) and other direct government involvement in health care; complex and seemingly inappropriate legal decisions; liability chaos; and increasing competition from peers, entrepreneurs, and other health care organizations. In this new environment, an old player, the medical director (vice president of medical affairs) has been given new visibility and increased responsibilities to help physicians live with and overcome these environmental factors. In showing how the medical director can be of assistance in putting these factors into perspective, it is helpful to take a look at some aspects of the history of medicine, analyze the education process for physicians, point out where the profession began to be driven off course, and identify some of the overall problems of the profession and of the health care field. It is my intent here to project the position of medical director as a vital, frequently missing, link in the attempt to maximize communications, understanding, and achievement in health care organizations.

The facility operations director (FOD) and responsible line manager (RLM) play leadership and functional roles in the integrated work management (IWM) process at Los Alamos National Laboratory (LANL). This course, Integrated Work Management: FOD/RLM (COURSE 31882), describes the IWM roles and responsibilities of the FOD and the RLM; it also discusses IWM requirements that must be met by the FOD and the RLM. Before taking this course, you may want to take COURSE 31881, Integrated Work Management: Overview. This self-study course would be particularly helpful if you are unfamiliar with the IWM process. You should also read Procedure (P) 300, Integrated Work Management. This course briefly covers the roles of the preparer and person in charge (PIC). For more in-depth instruction on the preparer’s role, see COURSE 31883, Integrated Work Management: Preparer. For instruction on the PIC’s role, see COURSE 31884, Integrated Work Management: PIC.

The paper explores what racial integration is. Furthermore, it scrutinises how racial integration is currently managed in South African Public schools. The main argument of the paper defends a deliberative conception of managing racial integration in South African public schools. In light of this, there is some form of hope to ...

The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Systems capabilities on ISHM (Integrated System Health Management) and autonomy have traditionally been addressed separately. This means that ISHM functions, such as anomaly detection, diagnostics, prognostics, and comprehensive system awareness have not been considered traditionally in the context of autonomy functions such as planning, scheduling, and mission execution. One key reason is that although they address systems capabilities, both ISHM and autonomy have traditionally individually been approached as independent strategies and models for analysis. Additionally, to some degree, a unified paradigm for ISHM and autonomy has been difficult to implement due to limitations of hardware and software. This paper explores a unified treatment of ISHM and autonomy in the context of distributed hierarchical autonomous operations.

Monitoring of plant protection product (PPP) residues in "Golden Delicious" apples was performed in 2011-2013, where 216 active substances were analysed with three analytical methods. Integrated pest management (IPM) production and improved IPM production were compared. Results were in favour of improved IPM production. Some active compounds determined in IPM production (boscalid, pyraclostrobin, thiacloprid and thiametoxam) were not found in improved IPM production. Besides that, in 2011 and 2012, captan residues were lower in improved IPM production. Risk assessment was also performed. Chronic exposure of consumers was low in general, but showed no major differences for IPM and improved IPM production for active substances determined in both types of production. Analytical results were compared with the European Union report of 2010 where 1.3% of apple samples exceeded maximum residue levels (MRLs), while MRL exceedances were not observed in this survey.

Full Text Available Objective: To determine if pharmacist-provided medication therapy management (MTM improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR. Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR. Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8. Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43. However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08 following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.

The aim of this paper is to present the technical solution implemented in the present context for the management of law firms. The informational system consists of the automation of business processes using a BPM engine and electronic archiving using a DMS. The communication between the two modules is made by invoking web services. The whole system integrates modules like: project management, contract management, invoice management, collection, CRM, reporting.

The subject document reports the results of an in-depth investigation of the fiscal year 1992 cost of the city of Scottsdale, Arizona, integrated municipal solid waste management (IMSWM) system, the energy consumed to operate the system, and the environmental performance requirements for each of the system`s waste-processing and disposal facilities. The document reports actual data from records kept by participants. Every effort was made to minimize the use of assumptions, and no attempt is made to interpret the data reported. Analytical approaches are documented so that interested analysts may per-form manipulation or further analysis of the data. As such, the report is a reference document for municipal solid waste (MSW) management professionals who are interested in the actual costs and energy consumption, for a 1-year period, of an operating IMSWM system. The report is organized into two main parts. The first part is the executive summary and case study portion of the report. The executive summary provides a basic description of the study area and selected economic and energy information. Within the case study are detailed descriptions of each component operating during the study period; the quantities of solid waste collected, processed, and marketed within the study boundaries; the cost of MSW in Scottsdale; an energy usage analysis; a review of federal, state, and local environmental requirement compliance; a reference section; and a glossary of terms. The second part of the report focuses on a more detailed discourse on the above topics. In addition, the methodology used to determine the economic costs and energy consumption of the system components is found in the second portion of this report. The methodology created for this project will be helpful for those professionals who wish to break out the costs of their own integrated systems.

Full Text Available Data, data everywhere. The diversity and magnitude of the data generated in the Life Sciences defies automated articulation among complementary efforts. The additional need in this field for managing property and access permissions compounds the difficulty very significantly. This is particularly the case when the integration involves multiple domains and disciplines, even more so when it includes clinical and high throughput molecular data.The emergence of Semantic Web technologies brings the promise of meaningful interoperation between data and analysis resources. In this report we identify a core model for biomedical Knowledge Engineering applications and demonstrate how this new technology can be used to weave a management model where multiple intertwined data structures can be hosted and managed by multiple authorities in a distributed management infrastructure. Specifically, the demonstration is performed by linking data sources associated with the Lung Cancer SPORE awarded to The University of Texas MD Anderson Cancer Center at Houston and the Southwestern Medical Center at Dallas. A software prototype, available with open source at www.s3db.org, was developed and its proposed design has been made publicly available as an open source instrument for shared, distributed data management.The Semantic Web technologies have the potential to addresses the need for distributed and evolvable representations that are critical for systems Biology and translational biomedical research. As this technology is incorporated into application development we can expect that both general purpose productivity software and domain specific software installed on our personal computers will become increasingly integrated with the relevant remote resources. In this scenario, the acquisition of a new dataset should automatically trigger the delegation of its analysis.

Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.

Integrated environmental management became an economic necessity after industrial development proved to be unsustainable without consideration of environmental direct and indirect impacts. Energy dependency and air pollution along with climate change grew into major challenges facing developed and developing countries alike. Thus, a new global market structure emerged and changed the way we do trade. The search intensified for alternatives to petroleum. However, scientists, policy makers, and environmental activists agreed to focus on strategic conservation and optimization of energy use. Environmental concerns will remain partially unaddressed with the current pace of consumption because greenhouse gas emissions will continue to rise with economic growth. This paper discusses energy efficiency, steady integration of alternative sources, and increased use of best available technologies. Energy criteria developed for environmental labeling certification are presented. Our intention is to encourage manufacturers and service providers to supply consumers with less polluting and energy-consuming goods and services, inform consumers of the environmental and energy impacts, and thereby instill sustainable and responsible consumption. As several programs were initiated in developed countries, environmental labeling requirements created barriers to many exports manufactured in developing countries, affecting current world trade and putting more pressure on countries to meet those requirements. Defining an institutional and legal framework of environmental labeling is a key challenge in implementing such programs for critical economic sectors like tourism, textiles, and food production where energy needs are the most important aspect to control. A case study of Tunisia and its experience with eco-labeling is presented.

Video imagery can be acquired from aerial, terrestrial and marine based platforms and has been exploited for a range of remote sensing applications over the past two decades. Examples include coastal surveys using aerial video, routecorridor infrastructures surveys using vehicle mounted video cameras, aerial surveys over forestry and agriculture, underwater habitat mapping and disaster management. Many of these video systems are based on interlaced, television standards such as North America's NTSC and European SECAM and PAL television systems that are then recorded using various video formats. This technology has recently being employed as a front-line, remote sensing technology for damage assessment post-disaster. This paper traces the development of spatial video as a remote sensing tool from the early 1980s to the present day. The background to a new spatial-video research initiative based at National University of Ireland, Maynooth, (NUIM) is described. New improvements are proposed and include; low-cost encoders, easy to use software decoders, timing issues and interoperability. These developments will enable specialists and non-specialists collect, process and integrate these datasets within minimal support. This integrated approach will enable decision makers to access relevant remotely sensed datasets quickly and so, carry out rapid damage assessment during and post-disaster.

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA MedicalManagement, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality

Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group's pain management plans. Findings show that IP mentorship and IP group participation improved medical students' pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.

Full Text Available The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past, medical waste was often mixed with municipal solid waste and disposed in residential waste landfills or improper treatment facilities in Iran. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better managing the wastes from healthcare facilities. This study was carried in 12 educational hospitals of Tehran University of Medical Sciences. The goals of this study were to characterize solid wastes generated in healthcare hospitals, to report the current status of medical waste management and to provide a framework for the safe management of these wastes at the considered hospitals. The methodology was descriptive, cross-sectional and consisted of the use of surveys and interviews with the authorities of the healthcare facilities and with personnel involved in the management of the wastes. The results showed that medical wastes generated in hospitals were extremely heterogeneous in composition. 42% of wastes were collected in containers and plastic bags. In 75% of hospitals, the stay-time in storage sites was about 12-24h. 92% of medical wastes of hospitals were collected by covered-trucks. In 46% of hospitals, transferring of medical wastes to temporary stations was done manually. The average of waste generation rates in the hospitals was estimated to be 4.42kg/bed/day.

The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation.

A new Integrated Data Access Management system, IDAM, has been created to address specific data management issues of the MAST spherical Tokamak. For example, this system enables access to numerous file formats, both legacy and modern (IDA, Ufile, netCDF, HDF5, MDSPlus, PPF, JPF). It adds data quality values at the signal level, and automatically corrects for problems in data: in timings, calibrations, and labelling. It also builds new signals from signal components. The IDAM data server uses a hybrid XML-relational database to record how data are accessed, whether locally or remotely, and how alias and generic signal names are mapped to true names. Also, XML documents are used to encode the details of data corrections, as well as definitions of composite signals and error models. The simple, user friendly, API and accessor function library, written in C on Linux, is available for applications in C, C++, IDL and Fortran-90/95/2003 with good performance: a MAST plasma current trace (28 kbytes of data), requested using a generic name and with data corrections applied, is delivered over a 100 Mbit/s network in ∼13 ms

Full Text Available Maral J Rouhani,1 Eleanor J Burleigh,2 Chloe Hobbis,2 Charlotte Dunford,1 Nadir I Osman,3 Christine Gan,1 Norma B Gibbons,1 Hashim U Ahmed,1,4 Saiful Miah1,5 1Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; 2Medical School, University of Sheffield, Sheffield, UK; 3Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 4Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; 5Division of Surgery and Interventional Science, University College London, London, UK Background: We aimed to determine UK medical students’ perceptions and attitudes and interest toward medical leadership and clinician managers. Methods: A cross-sectional study was conducted during the academic year 2015–2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. Results: In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership

A clinical approach to the management of infertility in Africa is discussed. The role of Assisted Reproductive Techniques (ART), adoption and cloning in management of infertility in Africa is discussed. Key Words: Local Tetanus, Recurrence Piercing Injury, Foreign Objects Nigerian Medical Practitioner Vol. 46 No 1, 2004 ...

Medicalmanagement of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough ...

A generalized approach is proposed to support integrated traffic flow management decision making studies at both the U.S. national and regional levels. It can consider tradeoffs between alternative optimization and heuristic based models, strategic versus tactical flight controls, and system versus fleet preferences. Preliminary testing was accomplished by implementing thirteen unique traffic flow management models, which included all of the key components of the system and conducting 85, six-hour fast-time simulation experiments. These experiments considered variations in the strategic planning look-ahead times, the replanning intervals, and the types of traffic flow management control strategies. Initial testing indicates that longer strategic planning look-ahead times and re-planning intervals result in steadily decreasing levels of sector congestion for a fixed delay level. This applies when accurate estimates of the air traffic demand, airport capacities and airspace capacities are available. In general, the distribution of the delays amongst the users was found to be most equitable when scheduling flights using a heuristic scheduling algorithm, such as ration-by-distance. On the other hand, equity was the worst when using scheduling algorithms that took into account the number of seats aboard each flight. Though the scheduling algorithms were effective at alleviating sector congestion, the tactical rerouting algorithm was the primary control for avoiding en route weather hazards. Finally, the modeled levels of sector congestion, the number of weather incursions, and the total system delays, were found to be in fair agreement with the values that were operationally observed on both good and bad weather days.

The text is brief and directed primarily to the breast cancer specialist. Topics include epidemiology, screening, prognostic factors, pre- and postoperative assessment, surgery, radiotherapy adjuvant endocrine therapy, and management of advanced disease. Brief chapters also address nonspecific symptoms of advanced disease, male breast cancer, and psychological considerations. Emphasis is on clinical management and review of many published controlled trials. Chapters conclude with short lists of recommendations and long alphabetic lists of reference material from the world literature. Since breast cancer continues to increase gradually in incidence and is most common in the United States, it commands attention

The Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany, was founded in 1993 after the reunification of Germany. In 1999, a reform process of medical education was started together with Harvard Medical International. The traditional teacher and discipline-centred curriculum was replaced by a student-centred, interdisciplinary and integrative curriculum which has been named DIPOL (Dresden Integrative Patient/Problem- Oriented Learning). The reform process was accompanied and supported by a parallel-ongoing Faculty Development Program. In 2004, a Quality Management Program in medical education was implemented, and in 2005 medical education received DIN EN ISO 9001:2000 certification. Quality Management Program and DIN EN ISO 9001:2000 certification were/are unique for the 34 medical schools in Germany. The students played a very important strategic role in all processes. They were/are members in all committees like the Faculty Board, the Board of Study Affairs (with equal representation) and the ongoing audits in the Quality Management Program. Students are the only ones who experience all years of the curriculum and are capable of detecting, for example gaps, overlaps, inconsistencies of the curriculum and assessments. Therefore, the in-depth knowledge of students about the medical school's curriculum is a very helpful and essential tool in curriculum reform processes and Quality Management Programs of medical education. The reform in medical education, the establishment of the Quality Management program and the certification resulted in an improvement of quality and output of medical education and medical research.

implementation rate, which involved 31 out of the 38 patients in the target group. CONCLUSION: For patients with complex care needs, post-hospital medicationmanagement may be improved by a reconsideration of the activity-based funding of home healthcare, a recognition of the importance of organising work......AIMS AND OBJECTIVES: This study evaluates an intervention developed to improve patient safety in post-hospital medicationmanagement carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial inter-disciplinary home visit by nurses...... management is identified as the most challenging component of a discharge from the hospital to the home, in which discrepancies have been found in up to 94% of medication lists. DESIGN: A process evaluation inspired by the UK Medical Research Council's guidance. METHODS: The process evaluation was conducted...

A practical, small and low-cost diagnostic information management system has been developed for a comparative study of various medical imaging procedures, including ordinary radiography, X-ray computed tomography, emission computed tomography, and so forth. The purpose of the system is to effectively manage the original image data files and diagnostic descriptions during the various imaging procedures. A diagnostic description of each imaging procedure for each patient is made on a hand-sort punched-card with line-drawings and ordinary medical terminology and then coded and computerized using Index for Roentgen Diagnoses (American College of Radiology). A database management software (DB Master) on a personal computer (Apple II) is used for searching for patients' records on hand-sort punched-cards and finally original medical images. Discussed are realistic use of medical images and an effective form of diagnostic descriptions.

A practical, small and low-cost diagnostic information management system has been developed for a comparative study of various medical imaging procedures, including ordinary radiography, X-ray computed tomography, emission computed tomography, and so forth. The purpose of the system is to effectively manage the original image data files and diagnostic descriptions during the various imaging procedures. A diagnostic description of each imaging procedure for each patient is made on a hand-sort punched-card with line-drawings and ordinary medical terminology and then coded and computerized using Index for Roentgen Diagnoses (American College of Radiology). A database management software (DB Master) on a personal computer (Apple II) is used for searching for patients' records on hand-sort punched-cards and finally original medical images. Discussed are realistic use of medical images and an effective form of diagnostic descriptions. (author)

Background: Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa.Methods: We conducted a cross-sectional study on 48 medical practitioners at Od...

Full text: The number of nuclear power plants (NPPs) operating in the world has been roughly constant for the past seven years. There are 438 reactors of 353,489 MW(e) capacity in the world and they generated 2448.9 TWh in 2001 giving a total world operating experience with nuclear power of 10,363 years. About 230 units have reached already over 15 years of operation and significant number of these plants are fully depreciated. Share of nuclear power in electricity production sector in Member States utilising nuclear power plants represents a meaningful amount and in 14 countries it exceeds 30%. Therefore, a loss of this share should be covered by new installed capacities either from conventional or alternative sources of electricity generation. Recent forecasts, for nuclear power use over the next two decades range from ∼350 to ∼500 GW(e) worldwide. While assessing the need for any nuclear power related programmes there are several important factors that must be considered since even 350 GW(e) is a very large programme requiring several hundred thousand highly qualified personnel and a substantial infrastructure to assure its continued safe, reliable and cost-effective operation. It is important to assure reliable, safe and economic beneficial performance of the plant, which requires in turn an appropriated management of any activity connected with any taken period of a plant life starting from design and ending by the decided mode of decommissioning. The period between the first and the last payment for the activities connected with the existence of a plant could be defined as a life cycle of the plant. Such integrated approach requires considering the life cycle of the plant in a much broader sense than just operational life and is characterized by the variety of activities and their management represents in a whole a plant life management programme (PLIM). Therefore PLIM could be defined as an aggregate (totality) of technical, financial, economical and

Purpose. - The fast modifications in French medical legislation, the increasing number of litigations and the professional consequences for the practitioner warrant the necessity to recall the 'how to manage' a claim for medical error. Patients and methods. - Four cases of legal action against oncologists are presented. Results and discussion. - The importance of quality and traceability of the given information, the essential pieces of the medical file, the description of the different process steps and of the contradictory meeting are presented and discussed. Conclusion. - Beyond the control of medical and technical risks, the practitioners in general and the radiation oncologist in particular should learn on the daily management of the risk related to medical claim. (authors)

Full Text Available Abstract Integrated vector management (IVM is defined as "a rational decision-making process for the optimal use of resources for vector control" and includes five key elements: 1 evidence-based decision-making, 2 integrated approaches 3, collaboration within the health sector and with other sectors, 4 advocacy, social mobilization, and legislation, and 5 capacity-building. In 2004, the WHO adopted IVM globally for the control of all vector-borne diseases. Important recent progress has been made in developing and promoting IVM for national malaria control programmes in Africa at a time when successful malaria control programmes are scaling-up with insecticide-treated nets (ITN and/or indoor residual spraying (IRS coverage. While interventions using only ITNs and/or IRS successfully reduce transmission intensity and the burden of malaria in many situations, it is not clear if these interventions alone will achieve those critical low levels that result in malaria elimination. Despite the successful employment of comprehensive integrated malaria control programmes, further strengthening of vector control components through IVM is relevant, especially during the "end-game" where control is successful and further efforts are required to go from low transmission situations to sustained local and country-wide malaria elimination. To meet this need and to ensure sustainability of control efforts, malaria control programmes should strengthen their capacity to use data for decision-making with respect to evaluation of current vector control programmes, employment of additional vector control tools in conjunction with ITN/IRS tactics, case-detection and treatment strategies, and determine how much and what types of vector control and interdisciplinary input are required to achieve malaria elimination. Similarly, on a global scale, there is a need for continued research to identify and evaluate new tools for vector control that can be integrated with

questionnaire before discharge from hospital. Cases of mastitis were reported either directly to the researchers or were detected during regular follow-up telephone interviews at weeks 3, 8, 18 and 26. Women experiencing mastitis provided further information of their symptoms and the management and advice...

This report presents the results of the third phase of an on-going FHWA study on weather integration in Transportation Management Center (TMC) operations. The report briefly describes the earlier phases of the integration study, summarizes the findin...

Background: Managers and physicians have two important roles in healthcare organisations. However, several studies have identified problems in the manager–physician relationship and more knowledge is needed to improve the situation. Using theories on organisation, professions, and role taking to inform thinking, this thesis addresses one aspect of the manager-physician relationship, namely how managers handle their role in relation to the medical profession. This was studied in the context of...

It is a best-practice Oil and Gas pipeline integrity and reliability technique to apply integritymanagement cycles. This is conforms to the business principles of continuous improvement. This paper examines the integritymanagement cycle - both goals and objectives and subsequent component steps - from a business perspective. Traits that businesses require, to glean maximum benefit from such a cycle, are highlighted. A case study focuses upon an integrity and reliability process developed to apply to pipeline operators. installations. This is compared and contrasted to the pipeline integritymanagement cycle to underline both cycles. consistency with the principles of continuous improvement. (author)

...), and the fungal pathogen Mycoleptodiscus terrestris (Gerd.) Ostazeski, applied alone and in combination with one another, as an integrated weed management strategy against the nuisance aquatic plant, hydrilla...

Full Text Available Purpose: The primary goal was to improve medicationmanagement oversight for a severely mentally ill (SMI community-based population by developing a medication monitoring system based on current guidelines to optimize pharmacotherapy and minimize potential medication-related adverse effects. The secondary goal was improvement in coordination of care between healthcare providers. Methods: Guidelines for medication used for psychiatric indications were reviewed. A database of medication for psychiatric indications with monitoring recommendation was developed. Results: Medication regimens for 68 members of the Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT program qualified for review. Fourteen medications, carbamazepine, chlorpromazine, clozapine, fluphenazine and fluphenazine long-acting injections (LAI, haloperidol and haloperidol LAI, lithium, lurasidone, olanzapine, paliperidone and paliperidone LAI, perphenazine, quetiapine, risperidone and risperidone LAI, valproic acid/divalproex, and ziprasidone, were identified. In total, 111 medications are used on a monthly basis. Each member receives more than one medication qualifying for review. Additional monitoring parameters that were evaluated included changes in laboratory orders for members with insulin-dependent diabetes. Annual lipid panels were changed to every 6 months, if applicable. Conclusions and Future Directions: This medication monitoring program was developed to help ensure IMPACT members receive the most effective care and minimize potential medication-related adverse effects. The secondary goal was to improve coordination of care. Medication monitoring will be added as a continuous quality assurance measure. Lab results will be reviewed at least monthly. The medication monitoring program will be evaluated annually.

Full Text Available Introduction: The current literature supports the inclusion of inter-professional education in healthcare education. Changes in the structure and nature of the integratedmedical education and healthcare system provide some opportunities for interprofessional education among various professions. This study is an attempt to determine the perceptions of students and faculty members about interprofessional education in the context of the medical education and healthcare system. Methods: This qualitative content analysis study was conducted using purposeful sampling in 2012. Thirteen semi-structured interviews were conducted with 6 faculty members and 7 students at Tehran and Iran Universities of Medical Sciences. Data collection and analysis were concurrent. Results: Data analysis revealed four categories and nine subcategories. The categories emerging from individual interviews were “educational structure”, “mediating factors”, “conceptual understanding”, and “professional identity”. These categories are explained using quotes derived from the data. Conclusion: Matching the existing educational context and structure with IPE through removing barriers and planning to prepare the required resources and facilities can solve numerous problems associated with implementation and design of interprofessional training programs in Iran. In this way, promoting the development of a cooperative rather than a competitive learning and working atmosphere should be taken into account. The present findings will assist the managers and policy makers to consider IPE as a useful strategy in the integratedmedical education and healthcare system.

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research lit...

Sensitivity analysis estimates the relative contribution of the uncertainty in input values to the uncertainty of model outputs. Partial Rank Correlation Coefficient (PRCC) and Standardized Rank Regression Coefficient (SRRC) are methods of conducting sensitivity analysis on nonlinear simulation models like the IntegratedMedical Model (IMM). The PRCC method estimates the sensitivity using partial correlation of the ranks of the generated input values to each generated output value. The partial part is so named because adjustments are made for the linear effects of all the other input values in the calculation of correlation between a particular input and each output. In SRRC, standardized regression-based coefficients measure the sensitivity of each input, adjusted for all the other inputs, on each output. Because the relative ranking of each of the inputs and outputs is used, as opposed to the values themselves, both methods accommodate the nonlinear relationship of the underlying model. As part of the IMM v4.0 validation study, simulations are available that predict 33 person-missions on ISS and 111 person-missions on STS. These simulated data predictions feed the sensitivity analysis procedures. The inputs to the sensitivity procedures include the number occurrences of each of the one hundred IMM medical conditions generated over the simulations and the associated IMM outputs: total quality time lost (QTL), number of evacuations (EVAC), and number of loss of crew lives (LOCL). The IMM team will report the results of using PRCC and SRRC on IMM v4.0 predictions of the ISS and STS missions created as part of the external validation study. Tornado plots will assist in the visualization of the condition-related input sensitivities to each of the main outcomes. The outcomes of this sensitivity analysis will drive review focus by identifying conditions where changes in uncertainty could drive changes in overall model output uncertainty. These efforts are an integral

There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education. We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field. 26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation. The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify the most effective and cost-effective curriculum innovations, this

Waste as a management issue has been evident for over four millennia. Disposal of waste to the biosphere has given way to thinking about, and trying to implement, an integrated waste management approach. In 1996 the United Nations Environmental Programme (UNEP) defined 'integrated waste management' as 'a framework of reference for designing and implementing new waste management systems and for analysing and optimising existing systems'. In this paper the concept of integrated waste management as defined by UNEP is considered, along with the parameters that constitute integrated waste management. The examples used are put into four categories: (1) integration within a single medium (solid, aqueous or atmospheric wastes) by considering alternative waste management options (2) multi-media integration (solid, aqueous, atmospheric and energy wastes) by considering waste management options that can be applied to more than one medium (3) tools (regulatory, economic, voluntary and informational) and (4) agents (governmental bodies (local and national), businesses and the community). This evaluation allows guidelines for enhancing success: (1) as experience increases, it is possible to deal with a greater complexity; and (2) integrated waste management requires a holistic approach, which encompasses a life cycle understanding of products and services. This in turn requires different specialisms to be involved in the instigation and analysis of an integrated waste management system. Taken together these advance the path to sustainability

Integrating research with management: The case of Katavi National Park, Tanzania. ... national park: (i) reduced water flow caused by local damming of the Katuma River, ... to both management and policy makers for tackling these problems.

The Dallas Area Rapid Transit (DART) is leading the US 75 Integrated Corridor Management (ICM) Demonstration Project for the Dallas region. Coordinated corridor operations and management is predicated on being able to share transportation information...

The Dallas Area Rapid Transit (DART) is leading the US 75 Integrated Corridor Management (ICM) : Demonstration Project for the Dallas region. Coordinated corridor operations and management is : predicated on being able to share transportation informa...

The Dallas Area Rapid Transit (DART) is leading the US-75 Integrated Corridor Management (ICM) Demonstration Project for the Dallas region. Coordinated corridor operations and management is predicated on being able to share transportation information...

Home · What we do ... The research team will use evidence to develop an integrated climate smart flood management framework to support policymaking. ... The Ministry of Environment, Science, Technology, and Innovation will manage the ...

Through a wide range of information and topics, Integrated Watershed Management Principles and Practice shows how involved the watershed management planning process can be. The book is informative, and the author obviously has researched the subject thoroughly. The book's case...

As a concept, Integrated Solid Waste Management (ISWM) is a sustainable ... on the perspective of consumers on waste generation, collection and disposal. ... to effective solid waste management in the case study area; non-sorting and ...

PEM fuel cells remain an emerging technology in the vehicle market with several cost and reliability challenges that must be overcome in order to increase market penetration and acceptance. The DOE has identified the lack of a cost effective, reliable, and efficient air supply system that meets the operational requirements of a pressurized PEM 80kW fuel cell as one of the major technological barriers that must be overcome. This project leveraged Roots positive displacement development advancements and demonstrated an efficient and low cost fuel cell air management system. Eaton built upon its P-Series Roots positive displacement design and shifted the peak efficiency making it ideal for use on an 80kW PEM stack. Advantages to this solution include: • Lower speed of the Roots device eliminates complex air bearings present on other systems. • Broad efficiency map of Roots based systems provides an overall higher drive cycle fuel economy. • Core Roots technology has been developed and validated for other transportation applications. Eaton modified their novel R340 Twin Vortices Series (TVS) Roots-type supercharger for this application. The TVS delivers more power and better fuel economy in a smaller package as compared to other supercharger technologies. By properly matching the helix angle with the rotor’s physical aspect ratio, the supercharger’s peak efficiency can be moved to the operating range where it is most beneficial for the application. The compressor was designed to meet the 90 g/s flow at a pressure ratio of 2.5, similar in design to the P-Series 340. A net shape plastic expander housing with integrated motor and compressor was developed to significantly reduce the cost of the system. This integrated design reduced part count by incorporating an overhung expander and motor rotors into the design such that only four bearings and two shafts were utilized.

To determine the extent of pharmacist use in medicationmanagement, roles of school nurses, and use of other health care providers at elementary schools in North Carolina. Prospective survey of 153 (130 public and 23 private) elementary schools in four counties of North Carolina. A 21-question survey was e-mailed to the head administrator of each school (e.g., principal, headmaster) containing a Qualtrics survey link. Questions were designed to elicit information on school policies and procedures for medicationmanagement and use of health care providers, including pharmacists, in the schools. Responses were collected during a 2-month period. Representatives from 29 schools participated in the survey (19% response rate). All 29 schools reported having a school policy regarding medication administration during school hours. Of those, 27 schools reported consulting with nurses on their policies. Only 1 of 27 respondents reported consulting with pharmacists on medicationmanagement policies. The majority of the respondents (93.1%) stated that administrative staff was responsible for medication administration at the schools. Use of pharmacists in creating and reviewing policies for schools and actual medicationmanagement at schools was extremely low. The findings in this study reinforce the findings in previous studies that pharmacists are not being used and are not a major presence in elementary school health.

Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medicationmanagement, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need. Type: Idea Paper

The present guide has been prepared in order to provide guidance to medical and para-medical personnel regarding medicalmanagement of the different types of radiation accidents. It discusses briefly the physical aspects and biological effect of radiation, for the benefit of those who have not specialised in radiation medicine. The diagnosis, medicalmanagement and follow-up of persons involved in different types of radiation accidents are also dealt with. The implementation of the procedures described calls for organisation of appropriate facilities and provision of requisite equipment as well as education and training of the staff. It is emphasised that major radiation accidents are rare events and the multi-disciplinary nature of the response required to deal with them calls for proper planning and continuous liaison among plant management, radiation protection personnel, first-aid assistants and medical and paramedical staff. The organisation and conduct of emergency drills may help in maintaining preparedness of the medical facilities for efficient management of radiation casualities. (original). 64 refs., tabs., figs

Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.

The diversity of water resources endowments and the societal arrangements to use, manage, and govern water makes defining a single paradigm or lens through which to define, prioritize and evaluate interventions in the water sector particularly challenging. Integrated Water Resources Management (IWRM) emerged as the dominant intervention paradigm for water sector interventions in the early 1990s. Since then, while many successful implementations of IWRM have been demonstrated at the local, basin, national and trans-national scales, IWRM has also been severely criticized by the global water community as "having a dubious record that has never been comprehensively analyzed", "curiously ambiguous", and "ineffective at best and counterproductive at worst". Does IWRM hold together as a coherent paradigm or is it a convenient buzzword to describe a diverse collection of water sector interventions? We analyzed 184 case study summaries of IWRM interventions on the Global Water Partnership (GWP) website. The case studies were assessed to find the nature, scale, objectives and outcomes of IWRM. The analysis does not suggest any coherence in IWRM as a paradigm - but does indicate distinct regional trends in IWRM. First, IWRM was done at very different scales in different regions. In Africa two-thirds of the IWRM interventions involved creating national or transnational organizations. In contrast, in Asia and South America, almost two-thirds were watershed, basin, or local body initiatives. Second, IWRM interventions involved very different types of activities in different regions. In Africa and Europe, IWRM entailed creation of policy documents, basin plans and institution building. In contrast, in Asia and Latin America the interventions were much more likely to entail new technology, infrastructure or watershed measures. In Australia, economic measures, new laws and enforcement mechanisms were more commonly used than anywhere else.

This conference paper explored ways of integrating petroleum and exploration data obtained from different sources in order to provide more comprehensive data for various analysis purposes and to improve the integrity and consistency of integrated data. This paper proposes a methodology to enhance oil and gas industry data integration performance by cooperating data management utilities in Microsoft SQL Server database management system (DBMS) for small scale data integration without support of commercial software. By semi-automatically capturing metadata, data sources are investigated in detail, data quality problems are partially cleansed, and the performance of data integration is improved. 20 refs., 7 tabs., 1 fig.

Most every medical practice will embark at one time or another on a large and complex new project. The practice may, for instance, undertake a project in office construction or renovation, practice expansion, new technology, or a new large-scale event. The medical practice staff may find itself creating the project plan, overseeing its execution, and working through the plan day to day until its completion. In short, the staff may find itself responsible for project management. This article contains 40 specific, easy-to-implement project management strategies medical practice employees can use to manage both the large and small projects they undertake on behalf of the practice. It suggests effective project management strategies the staff can use before the onset of a new project as well as strategies to help define the project, to deliver the project, and to close and review the project. This article also describes five reasons medical practices often fail at project management and suggests more effective approaches that will ensure that the projects the medical practice undertakes are completed well, on time, and within budget.

In the last few years, integrated multi-modality systems have been developed, aimed at improving the accuracy of medical diagnosis correlating information from different imaging techniques. In this contest, a novel dual modality probe is proposed, based on an ultrasound detector integrated with a small field of view single photon emission gamma camera. The probe, dedicated to visualize small organs or tissues located at short depths, performs dual modality images and permits to correlate morphological and functional information. The small field of view gamma camera consists of a continuous NaI:Tl scintillation crystal coupled with two multi-anode photomultiplier tubes. Both detectors were characterized in terms of position linearity and spatial resolution performances in order to guarantee the spatial correspondence between the ultrasound and the gamma images. Finally, dual-modality images of custom phantoms are obtained highlighting the good co-registration between ultrasound and gamma images, in terms of geometry and image processing, as a consequence of calibration procedures

Full Text Available Half a decade has passed since the fifth revision of the medical law and mandatory appointment of a medical equipment safety manager (MESM in hospitals in Japan. During this period, circumstances have changed regarding maintenance of medical equipment (ME. We conducted a survey to examine these changes and the current situation in ME management. Maintenance of ME and related work were found to have increased in many hospitals, but the number of clinical engineering technologists (CETs has only slightly increased. The appointed MESM was a CET or physician in most hospitals. In hospitals where physicians were appointed as the MESM, 81% had operation managers. Many respondents commented that it was difficult for one person to cover all the tasks required by the MESM, due to a lack of knowledge, too much work, or other reasons. This suggests the importance of an operation manager for ME to work under the MESM.

Full Text Available SUMMARY AIM: This study was carried out in order to determine medical faculty students� time management skills. METHOD: This is a cross sectional study and was carried out between 13 -31 May 2010. The universe of the study comprised 513 medical faculty students and data collection was performed by using the Time Management Inventory (TMI from 420 students (%81,9 of the universe. For statistical analyses of data percentage, Kruskal-Wallis, One-way Anova, Mann-Whitney U, Student-t test and Pearson correlation analysis were used. RESULTS: Students� total time management points were minimum 44 and maximum 122. Total points� mean was 79,06±14,07 and also the median was 78 of Time Management Inventory. Total time management points of the fifth class students were higher than the others. There was no correlation between total time management points and ages of the students. Also there is no statistically significant difference between the males and females at the TMI points. CONCLUSION: According to the other studies the medical faculty students� total TMI mean points are low. The reason of this situation may be the pension school that someone else is planning most of students� time and inadequacy of awareness, knowledge and skills about time management. Enhancing awareness with useful knowledge and being full of resource about time management is essential. [TAF Prev Med Bull 2012; 11(1.000: 5-10

Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS). Medicationmanagement is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore a key marker of the extent to which the health practices in prison settings equate with those of the NHS. The research reported here considers the influences on medicationmanagement during the early stages of custody and the impact it has on prisoners. The study employed a qualitative design incorporating semi-structured interviews with 39 prisoners and 71 staff at 4 prisons. Participant observation was carried out in key internal prison locations relevant to the management of vulnerable prisoners to support and inform the interview process. Thematic analysis of the interview data and interpretation of the observational field-notes were undertaken manually. Emergent themes included the impact that delays, changes to or the removal of medication have on prisoners on entry to prison, and the reasons that such events take place. Inmates accounts suggested that psychotropic medication was found a key and valued form of support for people with mental health problems entering custody. Existing regimes of medication and the autonomy to self-medicate established in the community are disrupted and curtailed by the dominant practices and prison routines for the taking of prescribed medication. The continuity of mental health care is undermined by the removal or alteration of existing medication practice and changes on entry to prison which exacerbate prisoners' anxiety and sense of helplessness. Prisoners with a dual diagnosis are likely to be doubly vulnerable because of inconsistencies in substance

Full Text Available Abstract Background Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS. Medicationmanagement is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore a key marker of the extent to which the health practices in prison settings equate with those of the NHS. The research reported here considers the influences on medicationmanagement during the early stages of custody and the impact it has on prisoners. Methods The study employed a qualitative design incorporating semi-structured interviews with 39 prisoners and 71 staff at 4 prisons. Participant observation was carried out in key internal prison locations relevant to the management of vulnerable prisoners to support and inform the interview process. Thematic analysis of the interview data and interpretation of the observational field-notes were undertaken manually. Emergent themes included the impact that delays, changes to or the removal of medication have on prisoners on entry to prison, and the reasons that such events take place. Results and Discussion Inmates accounts suggested that psychotropic medication was found a key and valued form of support for people with mental health problems entering custody. Existing regimes of medication and the autonomy to self-medicate established in the community are disrupted and curtailed by the dominant practices and prison routines for the taking of prescribed medication. The continuity of mental health care is undermined by the removal or alteration of existing medication practice and changes on entry to prison which exacerbate prisoners' anxiety and sense of helplessness. Prisoners with a dual diagnosis are likely

Eating disorders are associated with deleterious health consequences, increased risk of mortality, and psychosocial impairment. Although individuals with eating disorders are likely to seek treatment in general medical settings such as primary care (PC), these conditions are often under-detected by PC providers. However, psychologists in integrated PC settings are likely to see patients with eating disorders because of the mental health comorbidities associated with these conditions. Further, due to their training in identifying risk factors associated with eating disorders (i.e., comorbid mental health and medical disorders) and opportunities for collaboration with PC providers, psychologists are well-positioned to improve the detection and management of eating disorders in PC. This paper provides a brief overview of eating disorders and practical guidance for psychologists working in integrated PC settings to facilitate the identification and management of these conditions.

The Analysis Subsection of Technical Service Section, Tokai Reprocessing Plant, Tokai Works, is engaged in analysis activities required for the management of processes and measurements in the plant. Currently, it has been desired to increase the reliability of analytical data and to perform analyses more rapidly to cope with the increasing number of analysis works. To meet this end, on-line data processing has been promoted and advanced analytical equipment has been introduced in order to enhance automization. In the present study, an integrated analytical data mangement system is developed which serves for improvement of reliability of analytical data as well as for rapid retrieval and automatic compilation of these data. Fabrication of a basic model of the system has been nearly completed and test operation has already been started. In selecting hardware to be used, examinations were made on easiness of system extension, Japanese language processing function for improving man-machine interface, large-capacity auxiliary memory system, and data base processing function. The existing analysis works wer reviewed in establishing the basic design of the system. According to this basic design, the system can perform such works as analysis of application slips received from clients as well as recording, sending, filing and retrieval of analysis results. (Nogami, K.)

Full Text Available Abstract Background The Zambian Malaria Control Programme with the Roll Back Malaria (RBM partners have developed the current National Malaria Strategic Plan (NMSP 2006–2011 which focuses on prevention based on the Integrated Vector Management (IVM strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. Achievements IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Conclusion Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

The improvement and rationalization of the plant construction technology has been promoted in order to shorten the construction period, to improve the quality and reliability, and especially to reduce construction costs. With the recent remarkable advances of computer technology, it is necessary to introduce an electronic information technology (IT) into the construction field, and to develop a business process. In such a situation, Hitachi has developed and applied integrated construction support system, which is consistent among design, production and construction. This system has design information and schedule information made electronically as a basic database, and characterizes with project management function based on that information. By introduction of this system, electronic processing of information and reduction of paperwork has enabled high efficiency and standardization of on-site indirect work. Furthermore, by collaboration with the civil company, electrical data exchange has been carried out and developed techniques to improve the interface between mechanical and civil work. High accuracy of construction planning and unification of schedule data have been achieved, and consequently, rework and adjustment at the job site have been greatly reduced. (author)

The goal of this work is to review the principles, design, and function of the ISS multilateral medical authority and the medical support system of the ISS Program. Multilateral boards and panels provide operational framework, direct, and supervise the ISS joint medical operational activities. The IntegratedMedical Group (IMG) provides front-line medical support of the crews. Results of ongoing activities are reviewed weekly by physician managers. A broader status review is conducted monthly to project the state of crew health and medical support for the following month. All boards, panels, and groups function effectively and without interruptions. Consensus prevails as the primary nature of decisions made by all ISS medical groups, including the ISS medical certification board. The sustained efforts of all partners have resulted in favorable medical outcomes of the initial fourteen long-duration expeditions. The medical support system appears to be mature and ready for further expansion of the roles of all Partners, and for the anticipated increase in the size of ISS crews.

Through analysis of medical and administrative director positions it is possible to identify an organizational structure for medical departments that enhances departmental operations. Possible roles and tasks that describe managerial responsibilities are considered, and a review of the literature identifies options for how these roles or tasks can be shared between medical and nonmedical managers at the departmental level. These options are refined based on interviews with department-level managers at a case study hospital. Three models are then explored: unity of command, shared accountability, and split accountability. The unity of command model is recommended. In this model, the medical director assumes total authority and accountability for departmental operations through some sort of "enfranchisement." A more formal planning process and a review of job descriptions are also recommended.

The medical issues in a radioactive fallout eventuality include radioprotectors, radioactivity de corporators, hemopoietic system regenerators, community and individual dosage issues, logistic and scale-up issues, regulatory issues. These issues are further compounded by the fact that published literature is (and will be) sparse and outdated, and pharma majors are unlikely to involve themselves in the R and D as well as in the supply chain. Self-developed out-of-box solutions are therefore needed. INMAS, DRDO has recently made progress on all these fronts. Many of these products have already been approved by DCGI and others are in an advanced development stage. Radioprotector has been and is an Achilles heals for the concerned scientists and a number of state agencies for a long time. However, it is a difficult area to work in for a number of reasons. New research in this area shall be highlighted. Finally, clinical trials, which are considered a norm and the final step before introduction of new drugs, are not strictly possible in case of decorporating agents and radioprotectors. Ways and means to collect safety-efficacy data shall be discussed

We compare the efficiency of (1) just-in-time data management, in which data are cleaned prior to each analysis, and (2) integrated data management, in which data are centralized, cleaned up front, and made available via a query interface. Integrated data management was associated with faster completion of data management requests.

This paper focuses on the following four main issues: (1) necessity for an integrated, regional approach to risk management of industrial systems; (2) principles of risk management; (3) integrated approach and overall methodology; and (4) implementation of risk management strategies on a regional basis. The U.N. Interagency project on risk management for large industrial areas, which is a pioneer type of international initiative for an integrated approach to risk management, is discussed in this context. Another encouraging activity for further development of overall methodologies for risk management is the ongoing project on the risk and safety of technical systems at the Swiss Federal Institute of Technology in Aurich. The concept of integral risk management takes into account multidimensional factors including technical, economic, political, social, and ethical considerations to allow a well-balanced decision-making process

In developing countries, solid wastes have not received sufficient attention. In many countries, hazardous and medical wastes are still handled and disposed together with domestic wastes, thus creating a great health risk to municipal workers, the public and the environment. Medical waste management has been evaluated at the Vacacai river basin in the State of Rio Grande do Sul, Brazil. A total of 91 healthcare facilities, including hospitals (21), health centers (48) and clinical laboratories (22) were surveyed to provide information about the management, segregation, generation, storage and disposal of medical wastes. The results about management aspects indicate that practices in most healthcare facilities do not comply with the principles stated in Brazilian legislation. All facilities demonstrated a priority on segregation of infectious-biological wastes. Average generation rates of total and infectious-biological wastes in the hospitals were estimated to be 3.245 and 0.570 kg/bed-day, respectively

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within

Full Text Available ​Background and Objectives : The purpose of this study was to study the role of knowledge creation and management skills of managers in Tabriz University of Medical Sciences. Material and Methods : This was a descriptive correlational study. The statistical population consisted of all managers (140 managers in Tabriz University of Medical Sciences. Census sampling method was used due to limited statistical population. The data were collected through management skills and knowledge creation questionnaire developed by Goudarzi (2002. The reliability was 0.933 and 0.792 respectively using Cronbach's alpha. The validity of the questionnaire was verified by management faculty members. Pearson correlation and multiple regression analysis were used to analyze the data. Results : Results showed that there was a positive relationship between knowledge creation and management skills of the managers. In addition, there was a positive and significant relationship between the management skills indicators (human, conceptual and technical and the knowledge creation variables. Multiple regression results indicated that the knowledge creation dimensions had a predictive role in human, perceptual and technical skills. A significant relationship between knowledge creation and management skills of managers indicated that managers should have access to the up-to-date knowledge to promote it in order to execute it at all levels within the organization to improvement staff and organization creativity. Conclusion : The results demonstrated that the enhancement of organizational knowledge creation and its dimensions lead to improvement of management skills. Managers need to have dynamic capabilities to move towards knowledge creation and make the best use of available and potential resources of the organization to achieve these capabilities and identify, acquire, apply, integrate and combine the information, knowledge and skills.

The medicalmanagement of youth baseball and softball tournaments requires both proper planning and a basic awareness of commonly seen sport-specific injuries. While youth sporting events are designed to be a fun experience for all, injuries and emergencies will occur. With proper planning, and supplies, the impact of these issues can be minimized. This article will outline some basic principles for the medical personnel that may be involved in youth baseball and softball events.

Radio Frequency Identification (RFID) and Wireless Sensor Network (WSN) are two important wireless technologies that have wide variety of applications and provide unlimited future potentials most especially in healthcare systems. RFID is used to detect presence and location of objects while WSN is used to sense and monitor the environment. Integrating RFID with WSN not only provides identity and location of an object but also provides information regarding the condition of the object carrying the sensors enabled RFID tag. However, there isn't any flexible and robust communication infrastructure to integrate these devices into an emergency care setting. An efficient wireless communication substrate for medical devices that addresses ad hoc or fixed network formation, naming and discovery, transmission efficiency of data, data security and authentication, as well as filtration and aggregation of vital sign data need to be study and analyze. This paper proposed an efficient next generation architecture for RFID-based medical service management system in WSN that possesses the essential elements of each future medical application that are integrated with existing medical practices and technologies in real-time, remote monitoring, in giving medication, and patient status tracking assisted by embedded wearable wireless sensors which are integrated in wireless sensor network.

This paper describes a mobile Electronic Medical Record (EMR) platform designed to manage and utilize the existing EMR and mobile application with optimized resources. We structured the mEMR to reuse services of retrieval and storage in mobile app environments that have already proven to have no problem working with EMRs. A new mobile architecture-based mobile solution was developed in four steps: the construction of a server and its architecture; screen layout and storyboard making; screen user interface design and development; and a pilot test and step-by-step deployment. This mobile architecture consists of two parts, the server-side area and the client-side area. In the server-side area, it performs the roles of service management for EMR and documents and for information exchange. Furthermore, it performs menu allocation depending on user permission and automatic clinical document architecture document conversion. Currently, Severance Hospital operates an iOS-compatible mobile solution based on this mobile architecture and provides stable service without additional resources, dealing with dynamic changes of EMR templates. The proposed mobile solution should go hand in hand with the existing EMR system, and it can be a cost-effective solution if a quality EMR system is operated steadily with this solution. Thus, we expect this example to be shared with hospitals that currently plan to deploy mobile solutions.

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

Full Text Available The correctly lined up management system is an important element of intellectual capital of company and promotes growth of its market value. In the article grounded, that realization of strategy is impossible without intercommunication of strategic management and business-process management. Such organizational aspects of administrative activity, as role conception of management, strategic office and process office, are observed.

The Law for Integral Waste Management No. 8839 was enacted in Costa Rica in 2010. The purpose of this law has been to regulate the integralmanagement of residues and the efficient use of the resources, through the planning and execution of regulatory actions, operational, financial, administrative, educational, environmental and healthy of monitoring and evaluation [es

There are serious short- and long-term consequences on human health, physical assets, economic ... To work, adaptive climate-proof integrated urban water management must extend throughout the whole catchment, an approach known as integrated water resource management. ... Careers · Contact Us · Site map.

The low productivity of smallholder farming systems and enterprises in the drier areas of the developing world can be attributed mainly to the limited resources of farming households and the application of inappropriate skills and practices that can lead to the degradation of the natural resource base. This lack of development, particularly in southern Africa, is of growing concern from both an agricultural and environmental perspective. To address this lack of progress, two development paradigms that improve land and water productivity have evolved, somewhat independently, from different scientific constituencies. One championed by the International Agricultural Research constituency is Integrated Natural Resource Management (INRM), whilst the second championed predominantly by Environmental and Civil Engineering constituencies is Integrated Water Resources Management (IWRM). As a result of similar objectives of working towards the millennium development goals of improved food security and environmental sustainability, there exists a nexus between the constituencies of the two paradigms, particularly in terms of appreciating the lessons learned. In this paper lessons are drawn from past INRM research that may have particular relevance to IWRM scientists as they re-direct their focus from blue water issues to green water issues, and vice-versa. Case studies are drawn from the management of water quality for irrigation, green water productivity and a convergence of INRM and IWRM in the management of gold panning in southern Zimbabwe. One point that is abundantly clear from both constituencies is that ‘one-size-fits-all’ or silver bullet solutions that are generally applicable for the enhancement of blue water management/formal irrigation simply do not exist for the smallholder rainfed systems.

The Medical Advisers to the Atomic Energy Control Board provide advice to occupational and family physicians treating overexposed workers. GMA-7 provides information and guidance to medical practitioners on the medicalmanagement of individuals who have been overexposed to tritiated water. Various treatment principles are presented with special emphasis on techniques for facilitating removal of tritiated water from the body so as to reduce the total radiation dose. Risks and biological effects from exposures to tritiated water and various radiation protection precautions are also discussed. 32 refs., 1 tab.

The Medical Advisers to the Atomic Energy Control Board provide advice to occupational and family physicians treating overexposed workers. GMA-7 provides information and guidance to medical practitioners on the medicalmanagement of individuals who have been overexposed to tritiated water. Various treatment principles are presented with special emphasis on techniques for facilitating removal of tritiated water from the body so as to reduce the total radiation dose. Risks and biological effects from exposures to tritiated water and various radiation protection precautions are also discussed. 32 refs., 1 tab

The Medical Advisers to the Atomic Energy Control Board provide advice to occupational and family physicians treating overexposed workers. GMA-7 provides information and guidance to medical practitioners on the medicalmanagement of individuals who have been overexposed to tritiated water. Various treatment principles are presented with special emphasis on techniques for facilitating removal of tritiated water from the body so as to reduce the total radiation dose. Risks and biological effects from exposures to tritiated water and various radiation protection precautions are also discussed. 32 refs., 1 tab

Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan-Do-Study-Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management.

Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medicationmanagement services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.

Integration in its simplest form involves seamless coordination between organizational elements such as organization structure, processes, systems and documents. This paper discusses the concept of integration in regards to managed systems and examines practical issues of marrying evolving standards to organizational design and overall governance. Bruce Power's experience in developing its Management System into a more integrated approach is described. Leadership sponsorship of an integrated programmatic approach using a Governance, Oversight, Support and Perform (GOSP) model of accountability framework within the Management System has been a critical success factor in Bruce Power's journey towards achieving operational excellence. (author)

Integration in its simplest form involves seamless coordination between organizational elements such as organization structure, processes, systems and documents. This paper discusses the concept of integration in regards to managed systems and examines practical issues of marrying evolving standards to organizational design and overall governance. Bruce Power's experience in developing its Management System into a more integrated approach is described. Leadership sponsorship of an integrated programmatic approach using a Governance, Oversight, Support and Perform (GOSP) model of accountability framework within the Management System has been a critical success factor in Bruce Power's journey towards achieving operational excellence. (author)

The basic principles and contents of an integratedmanagement system are presented. The report focuses on the benefits and the experience accumulated in using an integratedmanagement system. Integratedmanagement systems are characterized by 2 features in particular: - On the one hand, by a system holistically controlling and describing all processes within a company which are necessary to achieve the company policy and company goals as defined. - On the other hand, it combines in one integratedmanagement system various different aspects (such as quality, environmental protection, and safety) and the resulting requirements. Successful implementation of an integratedmanagement system requires a clear commitment by company management to the integratedmanagement system serving as a management tool. Implementation must be assigned the appropriate importance in the company. It must not be viewed as an instrument preserving 'status quo.' Instead, it must be seen as a tool for long-term improvement of the company. Application of the integratedmanagement system minimizes the probability of occurrence of events, but is not able to reduce it to zero. (orig.)

Commercial versions of CANDU reactors were put into service starting more than 25 years ago. The first unit of Ontario Hydro's Pickering A station was put into service in 1971, and Bruce A in 1977. Most CANDU reactors, however, are only now approaching their mid-life of 15 to 20 years of operation. In particular, the first series of CANDU 6 plants which entered service in the early 1980's were designed for a 30 year life and are now approaching mid life. The current CANDU 6 design is based on a 40 year life as a result of advancement in design and materials through research and development. In order to assure safe and economic operation of these reactors, a comprehensive CANDU Plant Life Management (PLIM) program is being developed from the knowledge gained during the operation of Ontario Hydro's Pickering, Bruce, and Darlington stations, worldwide information from CANDU 6 stations, CANDU research and development programs, and other national and international sources. This integration began its first phase in 1994, with the identification of most of the critical systems structures and components in these stations, and a preliminary assessment of degradation and mechanisms that could affect their fitness for service for their planned life. Most of these preliminary assessments are now complete, together with the production of the first iteration of Life Management Plans for several of the systems and components. The Generic CANDU 6 PLIM program is now reaching its maturity, with formal processes to systematically identify and evaluate the major CSSCs in the station, and a plan to ensure that the plant surveillance, operation, and maintenance programs monitor and control component degradation well within the original design specifications essential for the plant life attainment. A Technology Watch program is being established to ensure that degradation mechanisms which could impact on plant life are promptly investigated and mitigating programs established. The

There are many internationally recognized codes and standards, such as API 1160 and ASME B31.8S, which help pipeline operators to manage and maintain the integrity of their pipeline networks. However, operators in many countries still use local codes that often reflect the history of pipeline developments in their region and are based on direct experience and research on their pipelines. As pipeline companies come under increasing regulatory and financial pressures to maintain the integrity of their networks, it is important that operators using regional codes are able to benchmark their integritymanagement schemes against these international standards. Any comprehensive Pipeline IntegrityManagement System (PIMS) software package should therefore not only incorporate industry standards for pipeline integrity assessment but also be capable of implementing regional codes for comparison purposes. This paper describes the challenges and benefits of incorporating one such set of regional pipeline standards into ROSEN Asset IntegrityManagement Software (ROAIMS). (author)

The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2 - 3 Gy), gastrointestinal (doses 5- 12 Gy) and cerebrovascular syndrome (doses 10 - 20 Gy). There is no possibility to survive after doses >10 - 12 Gy. The Phases of ARS are - prodromal: 0 - 2 days from exposure, latent: 2 - 20 days, and manifest illness: 21 - 60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 micro g/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome. (authors)

Video databases became an active field of research during the last decade. The main objective in such systems is to provide users with capabilities to friendly search, access and playback distributed stored video data in the same way as they do for traditional distributed databases. Hence, such systems need to deal with hard issues : (a) video documents generate huge volumes of data and are time sensitive (streams must be delivered at a specific bitrate), (b) contents of video data are very hard to be automatically extracted and need to be humanly annotated. To cope with these issues, many approaches have been proposed in the literature including data models, query languages, video indexing etc. In this paper, we present SIRSALE : a set of video databases management tools that allow users to manipulate video documents and streams stored in large distributed repositories. All the proposed tools are based on generic models that can be customized for specific applications using ad-hoc adaptation modules. More precisely, SIRSALE allows users to : (a) browse video documents by structures (sequences, scenes, shots) and (b) query the video database content by using a graphical tool, adapted to the nature of the target video documents. This paper also presents an annotating interface which allows archivists to describe the content of video documents. All these tools are coupled to a video player integrating remote VCR functionalities and are based on active network technology. So, we present how dedicated active services allow an optimized video transport for video streams (with Tamanoir active nodes). We then describe experiments of using SIRSALE on an archive of news video and soccer matches. The system has been demonstrated to professionals with a positive feedback. Finally, we discuss open issues and present some perspectives.

The Medical Information, Communication and Archive System (MICAS) is a multi-modality integrated image management system that is seamlessly integrated with the Radiology Information System (RIS). This project was initiated in the summer of 1995 with the first phase being installed during the first half of 1997 and the second phase installed during the summer of 1998. Phase II enhancements include a permanent archive, automated workflow including modality worklist, study caches, NT diagnostic workstations with all components adhering to Digital Imaging and Communications in Medicine (DICOM) standards. This multi-vendor phased approach to PACS implementation is designed as an enterprise-wide PACS to provide images and reports throughout our healthcare network. MICAS demonstrates that aa multi-vendor open system phased approach to PACS is feasible, cost-effective, and has significant advantages over a single vendor implementation.

Purpose - The purpose of this paper is to explore how healthcare managers construct the manager role in relation to the medical profession in their organisations. Design/methodology/approach - In total, 18 of Sweden's 20 healthcare chief executive officers (CEOs) and 20 clinical department managers (CDMs) were interviewed about their views on management of physicians. Interviews were performed in the context of one aspect of healthcare management; i.e., management of physicians' sickness certification practice. A discourse analysis approach was used for data analysis. Findings - Few managers used a management-based discourse to construct the manager role. Instead, a profession-based discourse dominated and managers frequently used the attributes "physician" or "non-physician" to categorise themselves or other managers in their managerial roles. Some managers, both CEOs and CDMs, shifted between the management- and profession-based discourses, resulting in a kind of "yes, but […]" approach to management in the organisations. The dominating profession-based discourse served to reproduce the power and status of physicians within the organisation, thereby rendering the manager role weaker than the medical profession for both physician and non-physician managers. Research limitations/implications - Further studies are needed to explore the impact of gender, managerial level, and basic profession on how managers construct the manager role in relation to physicians. Practical implications - The results suggest that there is a need to address the organisational conditions for managers' role taking in healthcare organisations. Originality/value - Despite the general strengthening of the manager position in healthcare through political reforms during the last decades, this study shows that a profession-based discourse clearly dominated in how the managers constructed the manager role in relation to the medical profession on the workplace level in their organisations.

The ManagementIntegration Panel of the Space Station Operations Task Force was chartered to provide a structure and ground rules for integrating the efforts of the other three panels and to address a number of cross cutting issues that affect all areas of space station operations. Issues addressed include operations concept implementation, alternatives development and integration process, strategic policy issues and options, and program management emphasis areas.

dissertation presents a bottom-up highly resolved model of a generic residential energy eco-system in the United States. The model is able to capture the entire energy footprint of an individual household, to include all appliances, space conditioning systems, in-home charging of plug-in electric vehicles, and any other energy needs, viewing residential and transportation energy needs as an integrated continuum. The residential energy eco-system model is based on a novel bottom-up approach that quantifies consumer energy use behavior. The incorporation of stochastic consumer behaviors allows capturing the electricity consumption of each residential specific end-use, providing an accurate estimation of the actual amount of available controllable resources, and for a better understanding of the potential of residential demand response programs. A dynamic energy management framework is then proposed to manage electricity consumption inside each residential energy eco-system. Objective of the dynamic energy management framework is to optimize the scheduling of all the controllable appliances and in-home charging of plug-in electric vehicles to minimize cost. Such an automated energy management framework is used to simulate residential demand response programs, and evaluate their impact on the electric power infrastructure. For instance, time-varying electricity pricing might lead to synchronization of the individual residential demands, creating pronounced rebound peaks in the aggregate demand that are higher and steeper than the original demand peaks that the time-varying electricity pricing structure intended to eliminate. The modeling tools developed in this study can serve as a virtual laboratory for investigating fundamental economic and policy-related questions regarding the interplay of individual consumers with energy use. The models developed allow for evaluating the impact of different energy policies, technology adoption, and electricity price structures on the total

Severe traumatic brain injury (sTBI) is a major contributor to long-term disability and a leading cause of death worldwide. Medicalmanagement of the sTBI patient, beginning with prehospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of sTBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation guidelines for the management of severe traumatic brain injury are highlighted.

Full Text Available Integration of management systems for quality, environment, health and risk management as well as corporative social responsibilities is workable corporative approach to reduce costs, effective use of resources, higher motivation of employees and better fulfillment of requirements of social engagements and stakeholders. This paper presents contents of literature and review of a company motives on integratedmanagement system (IMS implementation, namely factors affecting the IMS implementation.

Dotoral thesis ERGONOMICS INTEGRATION IMPROVING PRODUCTION PROCESS MANAGEMENT IN ENTERPRISES OF LATVIA ANNOTATION Ergonomics integration in process management has great significance in organisations` growth of productivity. It is a new approach to entrepreneurship and business strategy, where ergonomic aspects and values are taken into account in ensuring the effective process management and profitability of enterprises. This study is aimed at solution of the problem of e...

The aim of this paper is to present a conceptual model of the integrated strategic performance management system. This model is conceptual framework designed as a result of research that shows significant benefits of integrated application of strategic management and performance management in organizations. The framework consists of five steps: establishing a planning system, establishing of performance measurement system, establishing an accountability system, establishing of the knowledge m...

An IWMP outlines how the tribe will reduce, manage, and dispose of its waste. It identifies existing waste systems, assesses needs, and sets forth the ways to design, implement, and monitor a more effective and sustainable waste management program.

A record of a school district's assets--land, buildings, machinery, and equipment--can be a useful management tool that meets accounting requirements and provides appropriate information for budgeting, forecasting, and facilities management. (MLF)

The large numbers of technologies currently incorporated into mobile devices transform them into excellent tools for capture and to manage the information, because of the increasing computing power and storage that allow to add many miscellaneous applications. In order to obtain benefits of these technologies, in the biomedical engineering field, it was developed a mobile information system for medical equipment management. The central platform for the system it's a mobile phone, which by a connection with a web server, it's capable to send and receive information relative to any medical equipment. Decoding a type of barcodes, known as QR-Codes, the management process is simplified and improved. These barcodes identified the medical equipments in a database, when these codes are photographed and decoded with the mobile device, you can access to relevant information about the medical equipment in question. This Project in it's actual state is a basic support tool for the maintenance of medical equipment. It is also a modern alternative, competitive and economic in the actual market.

Based on over 40 years of experience in the field, Ramesh Singh goes beyond corrosion control, providing techniques for addressing present and future integrity issues. Pipeline Integrity Handbook provides pipeline engineers with the tools to evaluate and inspect pipelines, safeguard the life cycle of their pipeline asset and ensure that they are optimizing delivery and capability. Presented in easy-to-use, step-by-step order, Pipeline Integrity Handbook is a quick reference for day-to-day use in identifying key pipeline degradation mechanisms and threats to pipeline integrity. The book begins

Globally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. eHealth offers opportunities to transform every step of the patient's medicines management journey. From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing, carer support, information acquisition and monitoring, to learning about medicines and their management in daily life. It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of these dimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but for many others more rigorous research is urgently needed. Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs to be established between evidence-based integration of technologies and constructive experimentation that could lead to a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, including low- and middle-income contries is required to realise the benefits of eHealth at scale.

staff, accountability, general HR efficiency, occupation-specific dispensation adjustments and performance management and development system efficiency, and availability of HR staff. All these characteristics were judged to be poor. Conclusion. HRM practices in this Eastern Cape medical complex were inadequate and a ...

... combination of the efforts from government, health professionals and the individual patients. Adequate education of the patients and the public can lead to behavioral change and reduction in NCDs while at the same time improving medication use behaviours. Keywords: NCDs, Drug management, Drug safety, Drug Use, ...

Background: Medical establishment such as hospitals and research institutes generate sizable amount of hazardous waste. Health care workers, patients are at risk of acquiring infection from sharps and contamination of environment with multiple drug resistant microorganisms if wastes are not properly managed.

This paper focuses specifically on the medicalmanagement of attention-deficit / hyperactivity disorder (ADHD) and the options currently available in South Africa. References are made to current thinking on the etiology of this disorder and the pharmacological principles involved in its treatment. This review will not try to ...

Full Text Available Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medicationmanagement across the continuum of care within a large integrated health-system.Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist’s medicationmanagement responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM follow-up.Adult patients with a predicted diagnosis-related group (DRG of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85% received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25% receiving MTM follow-up, 26 (65% completing a primary care visit after their first hospital discharge, and 23 (58% receiving a home care visit.Conclusion: Implementation of a pharmacist-led medicationmanagement pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.

Mental health professionals commonly conceptualize medicationmanagement for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

Full Text Available The importance of medical devices in everyday users/patients lives is imensse. This is the reason why emphasis must be put on safety during their use. Satisfactory safety level can be achived by implementation of quality and risk management standards. Medical device manufacturers must learn to deal with the potential risks by using theoretical and practical examples and measures in order to protect their users/patients and themselves from suffering huge losses arising from adverse events or recall of their products. The best moment for implementation of risk management methods and analysis begins from the device design and development through manufacturing, sales and distribution. These way medical device manufacturers will succseed in protecting their users/patients from serious adverse events and at the same time protect their brand and society status, while minimizing economic losses.

Full Text Available Healthcare organizations in Germany exploit the benefits of the ISO 9000 family of international standards as it became compulsory to implement a quality management system in accordance with ISO 9001 requirements. Until the innovative ISO 9001:2015 proposal it was no direct connection to the other management systems like risk management, knowledge management or environmental management. So far, only few bodies ensured interconnections between different systems of management or associated the quality management system with the strategic planning process. However, healthcare encapsulates supplementary requirements which affect a number of different systems. Additionally, the financial crisis has encouraged the trend to operate integrated reporting beyond financial aspects. This paper aims at presenting the experience on the development of integratedmanagement and reporting system integrated in an organization belonging to the health sector. The work clarifies the steps towards merging distinctly regulated management systems (quality, health or environmental management with strategic planning and controlling, via a Balanced Dashboard (Balanced Scorecard - BSC as well as integrated reporting according to the model International Integrated Reporting Initiative (IIRI in a German medical company - Radiologische Netzwerk Rheinland - RNR AG. Using the case study method, the paper's purpose is to highlight approaches and results of the company that could support practitioners from medical area and bezound. The literature review clarified theoretical concepts while the case study allowed converging comprehensive information and knowledge accumulated by RNR AG, thus helping to bridge the gap between literature on total integratedmanagement reporting and reporting system in healthcare.

The operational safety management of Nuclear Power Plants demands systematic planning and integrated control. NPPs are following the well-developed safety indicator systems proposed by IAEA Operational Safety Performance Indicator Programme, NRC Reactor Oversight Process or the other institutions. Integration of the systems is proposed to benefiting from the advantages of both systems and avoiding improper application into the real world. The authors analyzed the possibility and necessity for system integration, and propose an indicator system integrating method

Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integratesmedicationmanagement between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

We investigate how conventional asset managers account for environmental, social and governance factors (ESG) in their investment process. We do so on the basis of an international survey among fund managers. We find that many conventional managersintegrate responsible investing in their investment

Integrated river management is heralded as the new style of river management, but it has been preceded by a number of previous styles, and is unlikely to be the last. This article presents the first analysis of the evolution of river management using Spiral Dynamics (SD). SD provides a growth

Full Text Available The article deals with the analysis of the researches conducted in the field of safety management systems.Safety management system framework, methods and tools for safety analysis in Air Traffic Control have been reviewed.Principles of development of Integrated safety management system in Air Traffic Services have been proposed.

Full Text Available Aqib Chaudry, Amar Sodha, Ahmed Nur Faculty of Medicine, Imperial College London, London, UK We read with great interest the article by Rouhani et al1 exploring the perceptions, attitudes, and interest of UK medical students toward medical leadership. As medical students who recently completed an intercalated degree in health care management at Imperial College London, we can offer a unique perspective on this important issue.Authors' responseMaral J Rouhani,1 Eleanor J Burleigh,2 Chloe Hobbis,2 Charlotte Dunford,1 Nadir I Osman,3 Christine Gan,1 Norma B Gibbons,1 Hashim U Ahmed,1,4 Saiful Miah1,51Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; 2Medical School, University of Sheffield, Sheffield, UK; 3Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 4Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; 5Division of Surgery and Interventional Science, University College London, London, UK We read with great interest the response to our article1 by Chaudry et al. Their group have contemporary insight and valuable experience in this subject which can be attributed to the intercalated degrees they have undertaken in health care management. We are acutely aware that very few UK medical schools actually offer such an intercalated degree. However, we believe the proposal of Singh et al2 of a compulsory health care management BSc is a counterproductive one. Basic science and clinically orientated intercalated degrees expose the medical student to research techniques and methodology. At their very core, they inspire the medical mind and are not designed to instruct all doctors to be academic research scientists, but rather ensure that every clinician’s mind is tuned to continually evaluate standard practice, and ask can we do better? View the original paper by Rouhani and colleagues.

This report outlines the technical progress achieved for project DE-FC26-03NT41785 (Total Ore Processing Integration and Management) during the period 01 January through 31 March of 2006. (1) Work in Progress: Minntac Mine--Graphical analysis of drill monitor data moved from two-dimensional horizontal patterns to vertical variations in measured and calculated parameters. The rock quality index and the two dimensionless ({pi}) indices developed by Kewen Yin of the University of Minnesota are used by Minntac Mine to design their blasts, but the drill monitor data from any given pattern is obviously not available for the design of that shot. Therefore, the blast results--which are difficult to quantify in a short time--must be back-analyzed for comparison with the drill monitor data to be useful for subsequent blast designs. {pi}{sub 1} indicates the performance of the drill, while {pi}{sub 2} is a measure of the rock resistance to drilling. As would be expected, since a drill tends to perform better in rock that offers little resistance, {pi}{sub 1} and {pi}{sub 2} are strongly inversely correlated; the relationship is a power function rather than simply linear. Low values of each Pi index tend to be quantized, indicating that these two parameters may be most useful above certain minimum magnitudes. (2) Work in Progress: Hibtac Mine--Statistical examination of a data set from Hibtac Mine (Table 1) shows that incorporating information on the size distribution of material feeding from the crusher to the autogenous mills improves the predictive capability of the model somewhat (43% vs. 44% correlation coefficient), but a more important component is production data from preceding days (26% vs. 44% correlation coefficient), determined using exponentially weighted moving average predictive variables. This lag effect likely reflects the long and varied residence times of the different size fragments in the grinding mills. The rock sizes are also correlated with the geologic

, respectively, and manufacturing flexibility. Design/methodology/approach – Using hierarchical regression, data are analyzed from a sample of 343 manufacturing plants in Asia collected in 2013-2014 as part of the International Manufacturing Strategy Survey (IMSS VI). Findings – Internal integration and supply......Purpose – The purpose of this paper is to investigate the impact of internal integration, external integration and supply chain risk management on manufacturing flexibility, and the moderating effect of supply chain risk management on the relationships between internal and external integration...... chain risk management have a direct effect on manufacturing flexibility. Supply chain risk management moderates the relationship between external integration and flexibility. Research limitations/implications – Further research is needed to generalize beyond the flexibility performance of discrete...

Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient's family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient's family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.

In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.

Medical school professors and lecturers are often called to be practicing clinicians, researchers in their own field, in addition to executing their education and curricular responsibilities. Some further accumulate healthcare management responsibilities. These areas pose conflicting demands on time and intellectual activity, but despite their apparent differences, knowledge and skills from management, leadership and informatics may prove useful in helping to smooth these conflicts and hence increase personal effectiveness in these areas. This article tries to clarify some concepts and advance why training in management, leadership and health informatics would seem particularly useful for the medical academic. As opposed to the idea of educational dispersion/specialization, the concept of an integrative tetrahedronal education framework is advanced as a way to plan workshops and other faculty development activities which could be implemented transnationally as well as locally.

A system for training of coordination and cooperation of decision makers in emergency management has been under construction for some time. A first prototype of the system was developed in the MUSTER system. The system is being developed modularly with one module for each of the suborganisations...... involved in the complete preparedness: fire brigade, police, medical team, civil defence, etc. All these modules will in the end be integrated on a common integration platform, either to a fully-fledged system covering all aspects of training for the complete preparedness, or for creating a dedicated...

The medical imaging community uses the DICOM image format and protocol to store and exchange data. The Medical Data Manager (MDM) is an interface between DICOM compliant systems such as PACS and the EGEE Data Management System. It opens hospital imaging networks to the world scale Grid while protecting sensitive medical data. It can be accessed transparently from any gLite service. It is an important milestone towards adoption of Grid technologies in the medical imaging community. Hospitals continuously produce tremendous amounts of image data that is managed by local PACS (Picture Archiving and Communication Systems). These systems are often limited to a local network access although the community experiences a growing interest for data sharing and remote processing. Indeed, patient data is often spread out different medical data acquisition centers. Furthermore, researchers in the area often need to analyze large populations whose data can be gathered through federations of PACS. Opening PACS to the outer I...

Specialty pharmaceuticals are expensive injectable and infusion therapies used to treat patients with chronic or life-threatening diseases. The high cost of these agents and their frequent usage in chronic diseases represent not only challenges, but also opportunities for medicalmanagement programs to improve the quality of care and moderate the rapid cost escalation seen in the industry. The number and variety of these agents have been increasing significantly, with hundreds of drug candidates in the development pipeline. The specialty pharmacy industry also is going through a consolidation stage, both horizontally and vertically. Industry approaches to medicalmanagement include the acquisition of specialty pharmacy companies, restrictive contracting to achieve concentrated buying power, and the development of utilization management strategies.

Unfortunately, cliques aren't a problem that you left behind in high school. Workplace cliques can be just as or even more troubling for you today, especially if they have the potential to affect your career, employee morale and performance, and your medical practice more broadly. This article describes workplace cliques in detail. It provides examples of exclusionary and ostracizing behaviors that are often associated with cliques. And it describes the prevalence and effects of cliques in today's workplace. This article also provides practice managers with 10 tips for discouraging and managing cliques. It describes five common workplace cliques: management, veteran, prior relationship, status, and homophily. It offers medical staff employees 10 strategies for working effectively alongside of a clique. Finally this article describes the pitfalls and risks of belonging to a workplace clique.

The Space Asset Management Database (SAM-D) was implemented in order to effectively track known objects in space by ingesting information from a variety of databases and performing calculations to determine the expected position of the object at a specified time. While SAM-D performs this task very well, it is limited by technology and is not available outside of the local user base. Modeling and simulation can be powerful tools to exploit the information contained in SAM-D. However, the current system does not allow proper integration options for combining the data with both legacy and new M&S tools. A more capable data management infrastructure would extend SAM-D to support the larger data sets to be generated by the COI. A service-oriented architecture model will allow it to easily expand to incorporate new capabilities, including advanced analytics, M&S tools, fusion techniques and user interface for visualizations. Based on a web-centric approach, the entire COI will be able to access the data and related analytics. In addition, tight control of information sharing policy will increase confidence in the system, which would encourage industry partners to provide commercial data. SIMON is a Government off the Shelf information sharing platform in use throughout DoD and DHS information sharing and situation awareness communities. SIMON providing fine grained control to data owners allowing them to determine exactly how and when their data is shared. SIMON supports a micro-service approach to system development, meaning M&S and analytic services can be easily built or adapted. It is uniquely positioned to fill this need as an information-sharing platform with a proven track record of successful situational awareness system deployments. Combined with the integration of new and legacy M&S tools, a SIMON-based architecture will provide a robust SA environment for the NASA SA COI that can be extended and expanded indefinitely. First Results of Coherent Uplink from a

Full Text Available Research has pointed out opportunities and research agendas to integrate sustainability issues with supply chain and operations management. However, we find that it is still not mainstream practice to systematically take a sustainability approach in tackling supply chain and operations management issues. In this paper, we make use of behavioral theory to explain the current lack of integration. We conclude through abductive reasoning that the reasons for procrastinating integration of sustainability in supply chain and operations management research are the conflicting nature of the task and the inherent context, which is the focus on operations rather than environmental or social issues.

Full Text Available Adaptive resource management is a learning-by-doing approach to natural resource management. Its effective practice involves the activation, completion, and regeneration of the "adaptive management cycle" while working toward achieving a flexible set of collaboratively identified objectives. This iterative process requires application of single-, double-, and triple-loop learning, to strategically modify inputs, outputs, assumptions, and hypotheses linked to improving policies, management strategies, and actions, along with transforming governance. Obtaining an appropriate balance between these three modes of learning has been difficult to achieve in practice and building capacity in this area can be achieved through an emphasis on reflexive learning, by employing adaptive feedback systems. A heuristic reflexive learning framework for adaptive resource management is presented in this manuscript. It is built on the conceptual pillars of the following: stakeholder driven adaptive feedback systems; strategic adaptive management (SAM; and hierarchy theory. The SAM Reflexive Learning Framework (SRLF emphasizes the types, roles, and transfer of information within a reflexive learning context. Its adaptive feedback systems enhance the facilitation of single-, double-, and triple-loop learning. Focus on the reflexive learning process is further fostered by streamlining objectives within and across all governance levels; incorporating multiple interlinked adaptive management cycles; having learning as an ongoing, nested process; recognizing when and where to employ the three-modes of learning; distinguishing initiating conditions for this learning; and contemplating practitioner mandates for this learning across governance levels. The SRLF is a key enabler for implementing the "adaptive management cycle," and thereby translating the theory of adaptive resource management into practice. It promotes the heuristics of adaptive management within a cohesive

Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managedmedication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. The electronic signature is indispensable for the

The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based--databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine

...). The lessons learned from the 1997 Quadrennial Defense Review (QDR 1997) included the need for leadership guidance and integration of analytic activities to sort through the myriad issues that are always confronting the Department of Defense...

Objective: The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. Method: A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements…

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only ∼3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment

The objective of this paper is to examine the challenges in the water sector faced by Armenia today, and outline options for management and allocation of its water resources in the future, considering the need for a stable, transparent apublic sector management framework and sustainable resource use for long-term private investment and job creation, and for appropriate balances among water...

Plant life is no longer determined by components, almost everything can be replaced. A plant life management program should aim at actions and replacements being performed at the right time. In order to manage this there is need for experience feedback systems, a plant specific risk study and safety upgrades. (author)

Pesticides have a role in public health as part of sustainable integrated mosquito management. Other components of such management include surveillance, source reduction or prevention, biological control, repellents, traps, and pesticide-resistance management. We assess the future use of mosquito control pesticides in view of niche markets, incentives for new product development, Environmental Protection Agency registration, the Food Quality Protection Act, and improved pest management strate...

Full Text Available The organizational integrated computer system project management aims at achieving competitiveness by unitary, connected and personalised treatment of the requirements for this type of projects, along with the adequate application of all the basic management, administration and project planning principles, as well as of the basic concepts of the organisational information management development. The paper presents some aspects of organizational computer systems project management competitiveness with the specific reference to some Romanian companies’ projects.

To use community pharmacy medication records to identify patients whose asthma may not be well managed and then implement and evaluate a multidisciplinary educational intervention to improve asthma management. We used a multisite controlled study design. Forty-two pharmacies throughout Tasmania ran a software application that "data-mined" medication records, generating a list of patients who had received three or more canisters of inhaled short-acting beta(2)-agonists in the preceding 6 months. The patients identified were allocated to an intervention or control group. Pre-intervention data were collected for the period May to November 2006 and post-intervention data for the period December 2006 to May 2007. Intervention patients were contacted by the community pharmacist via mail, and were sent educational material and a letter encouraging them to see their general practitioner for an asthma management review. Pharmacists were blinded to the control patients' identities until the end of the post-intervention period. Dispensing ratio of preventer medication (inhaled corticosteroids [ICSs]) to reliever medication (inhaled short-acting beta(2)-agonists). Thirty-five pharmacies completed the study, providing 702 intervention and 849 control patients. The intervention resulted in a threefold increase in the preventer-to-reliever ratio in the intervention group compared with the control group (P < 0.01) and a higher proportion of patients in the intervention group using ICS therapy than in the control group (P < 0.01). Community pharmacy medication records can be effectively used to identify patients with suboptimal asthma management, who can then be referred to their GP for review. The intervention should be trialled on a national scale to determine the effects on clinical, social, emotional and economic outcomes for people in the Australian community, with a longer follow-up to determine sustainability of the improvements noted.

In daily activities, hospitals, as one of the important health care unit, generate both medical solid waste and non-medical solid waste. The occurrence of medical solid waste could be from the results of treatment activities, such as, in the treatment room for a hospital inpatient, general clinic, a dental clinic, a mother and child clinic, laboratories and pharmacies. Most of the medical solid waste contains infectious and hazardous materials. Therefore it should be managed properly, otherwise it could be a source of new infectious for the community around the hospital as well as for health workers themselves. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. One of the efforts that need to be done in improving the quality of the environment is to undertake waste management activities, because with proper waste management is the most important in order to achieve an optimal degree of human health. Health development in Indonesian aims to achieve a future in which the Indonesian people live in a healthy environment, its people behave clean and healthy, able to reach quality health services, fair and equitable, so as to have optimal health status, health development paradigm anchored to the healthy. The healthy condition of the individual and society can be influenced by the environment. Poor environmental quality is a cause of various health problems. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. This paper proposes a model for managing the medical solid waste in hospitals in Medan city, in order to create healthy environment around hospitals.

To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medicationmanagement, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

Risk Engineering Ltd is a Bulgarian private company founded in 1990 to provide engineering and consulting services applicable to each and every field of the energy sector. Since its establishment Risk Engineering Ltd develops, implement and apply a System for quality assurance, certified for the first time by BVQI (now Bureau Veritas Certification) in 1999 for conformity with the standard ISO 9001:1994. Later on, in connection with the revision of the standards of ISO 9000 series and introduction of the standard ISO 9001:2000 a Quality Management System in conformity with the standard ISO 9001:2000 was developed, introduced and certified. At present, Risk Engineering Ltd has got developed, documented, introduced and certified by Lloyd's Register Quality Assurance (LRQA) Quality Management System in compliance with ISO 9001:2008 on the process approach basis. On this basis and including the requirements of the ISO 14001:2004 (regarding the environment) and OHSAS 18001:2007 (regarding the health and occupational safety), Risk Engineering Ltd has developed and introduced IntegratedManagement System aim at achieving and demonstrating good results regarding protection of the environment, health and occupational safety. The processes under control by the IntegratedManagement System and applicable at the company are divided in two general types: A) Management processes: Strategic management and Management of the human resources. B) Processes describing the main activities: design/development process; project management; management of industrial projects and technical infrastructure project; construction, installation, repair and operation of power industry facilities; commercial activities and marketing; investigation of energy efficiency of industrial systems and certification of buildings regarding energy efficiency; consulting activity in the field of industry and energy as well as consultant in accordance with the Law of the Spatial Planning; management of the

This self-directed learning module highlights present practices of geriatric medicine that are commonly seen in an inpatient rehabilitation setting. It is a part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In particular, attention is given to update physiatrists in the geriatric medical advances in pharmacotherapeutic considerations, the management of hypertension, diabetes mellitus, urinary tract infections, and sleep disorders. To update the common present-day medical practices for older persons seen in a rehabilitation setting.

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to managemedications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medicationmanagement for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health